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Chapter 5 Physical activity Gillian Prior
5.1.1 Background Increasing physical activity among adults has long been the subject of public health promotion policies, and the White Paper Saving Lives: Our Healthier Nation emphasises the importance of physical activity as one of the key determinants of good health.1 The health benefits of a physically-active lifestyle are well documented. Physical activity is one of the major risk factors for coronary heart disease which has been targeted by government health strategies since the early 1990s.2,3 Lack of physical activity has been shown to contribute to a range of other health conditions such as non-insulin dependent diabetes and osteoporosis, while participation in physical activity promotes good mental health.4 In addition there have been for many years internationally-accepted recommendations about the amount and type of physical activity among adults that is beneficial for health.5 Physical activity questions have been included regularly in the Health Survey since it began in 1991. When the Health Survey adult physical activity module was first developed the recommended level of physical activity for adults was that they should take part in at least three occasions a week of vigorous activity lasting 20 minutes or more.6 By the mid-1990s however the emphasis shifted towards encouraging people to take part in regular activity at a moderate level. Although regular vigorous activity has been shown to produce maximum cardiac benefit for an individual, for the majority of the population this may have been an unrealistic target. It was felt that the greatest health gain for the population as a whole would be achieved by encouraging the least active to become a little more active, and so moderate activity became more important for health promotion. The recommended guidelines were revised to say that adults should take part in at least 30 minutes of moderate activity, ideally on a daily basis (at least five days a week).7 Recently the emphasis has shifted further, towards encouraging the accumulation of shorter bouts of activity (of as little as 10 minutes) in order to reach the daily target of 30 minutes.8,9,10 The Health Survey physical activity questions were revised for the 1997 and 1998 surveys to address the issue of accumulation, and to allow better estimation of the amount of time spent participating in different activities. 5.1.2 Methodology The Health Survey adult physical activity module was developed for the 1991 Health Survey, and the questions were repeated in the 1992-1994 surveys with minor changes in 1993-1994. The questions were included again in the 1997 and 1998 surveys, with further revisions.11,12 The original Health Survey questions were based on those used in the Allied Dunbar National Fitness Survey (ADNFS), which was carried out in 1989.13 The level of physical activity has been measured by the time spent being active, the intensity of the activity (in terms of energy expenditure) and the frequency with which it is done. Types of activity Four main types of activity were asked about in the questionnaire:
For each activity type informants were asked on how many days in the last four weeks they had participated in the activity for at least 15 minutes a time. They were then asked how long they had usually spent participating in the activity. For occupational activity, the concept of an 'occasion' was not applicable, so no data on frequency or duration was collected. In summary variables, occupational activity was counted as 20 days in the last four weeks for full-time workers and 12 days in the last four weeks for part-time workers. For walking, informants were asked on how many days they had taken more than one walk of at least 15 minutes. If they had taken more than one walk a day, the total time spent walking on that day was calculated as twice the average time per walk. Informants were also asked to assess their usual walking pace as 'fast (at least 4 miles per hour)', 'brisk', 'steady average' or 'slow'. For sports and exercise activities, informants were asked whether the effort of the activity was usually enough to make them out of breath or sweaty. Intensity level In order to create a summary classification for this chapter, activities have been classified into intensity levels, based on an estimate of the energy cost of the activities. The levels are:
For sports and exercise, activities were classified according to the nature of the activity, and the informant's assessment of the amount of effort involved. For example, 'swimming' was counted as 'vigorous' if the effort was usually enough to make the informant out of breath or sweaty, otherwise as 'moderate'.14 For walking, walks of 15 minutes or more at a 'brisk' or 'fast' pace were classified as 'moderate'. Walks at a 'slow' or 'steady average' pace were classified as 'light'. For home activity, informants were given examples of types of housework/gardening and DIY that counted as 'heavy' and 'light'. Heavy housework and heavy gardening/DIY were classified as 'moderate', other gardening/DIY as 'light' and light housework only as 'inactive'.15 For occupational activity (activity at work), a combination of factors was used for classification. The level of activity was assigned by combining the Standard Occupational Classification (SOC) code of the informant's job with the answer to a question about how physically active informants felt themselves to be in their jobs. For example, informants who said that they were very physically active in their jobs were only classified as doing 'vigorous' activity at work if their job was one of a short list of occupations; otherwise they were classified as 'moderately active' at work.16 5.2.1 Number of days' participation in different activities Table 5.1 shows the number of days' participation in the last four weeks in heavy housework, heavy manual/DIY, walking, sports and exercise and occupational activity (for at least 15 minutes a time), together with the mean number of days based on all informants (so that non-participation is counted as zero days). In addition the table shows a summary classification of the number of days' participation in any physical activity for at least 15 minutes a time. It should be noted that overall this classification probably over-estimates the number of active days, as it assumes that each type of activity was done on a different day. So, for example, if an informant had participated in heavy housework and walking on the same day, it would be counted as two days of activity in the summary classification. The activity type most commonly reported by men was sports and exercise. 42% of men reported having participated in some sports and exercise (of at least 15 minutes' duration) in the last four weeks. Participation in sports and exercise among women was lower at 36%; however this was still the second-most common activity type among women. Among both men and women the proportion participating in sports decreased rapidly with age. Nearly 8 out of 10 men aged 16-24 (77%) had done some sports, and 29% had participated on 20 days or more in the last four weeks. By age 45-54 just over a third of men (36%) had participated in sports and exercise, and only 6% had done so on 20 days or more. By age 75 and over only 7% of men had done any sports and exercise. The mean number of days' sports and exercise peaked at 11.4 among men aged 16-24, falling to 3.4 among men aged 45-54. In younger age groups (up to age 35-44) men were significantly more
likely than women to have done any sports; in the older age groups (age
45 and over) the proportions of men and women reporting any participation
in sports were roughly the same. 57% of women aged 16-24 had participated
in sports, and 11% had done so on 20 days or more. By age 45-54, 36%
of women reported any sports participation, the same proportion as among
men. The mean number of days' participation in sports fell from 5.9
among women aged 16-24 to 3.2 among those aged 45-54 and 0.3 among those
aged 75 and over. Among women the most common type of activity was heavy housework; 58% of women had participated in this in the last four weeks. Participation in housework was lower among men at 38% overall, although it was the second most common activity type for men. In all except the oldest age group the proportion of women who had participated in heavy housework was higher than of men. Among women, participation in housework initially increased with age from around a half of those aged 16-24, to around 7 in 10 of those aged 25-44, before falling to around 6 in 10 among those aged 45-64, and just over a quarter of women aged 75 and over. The mean number of days' housework peaked at 4.6 among women aged 35-44. Among men, participation in heavy housework was lowest in those aged
16-24 (28%), rising to 45% among those aged 25-34, falling again to
31% in men aged 55-64. There was a second smaller peak in participation
in housework among men of retirement age - 40% of men aged 65-74
reported having done some heavy housework. The proportion fell again
among those aged 75 and over. The number of days' housework reported
by men was significantly lower than for women overall, with a peak of
2.5 days among men aged 65-74. The third major component of activity was walking; 32% of men and 24% of women had participated in walking (at a fast or brisk pace) in the last four weeks. Among men there was a steady decline with age in the proportion reporting any walking, from 53% of men aged 16-24 to 32% of those aged 45-54 and 9% of those aged 75 and over. The mean number of days similarly fell from 8.9 in men aged 16-24 to 1.4 in those aged 75 and over. Among women, although the proportion reporting any walking fell with
age the decline was less marked than among men. 35% of women aged 16-24
had participated in walking, falling to 26% of those aged 45-54 and
6% of those aged 75 and over. The mean number of days' walking among
women similarly fell from 5.4 in women aged 16-24, to 3.9 in those aged
45-54 and 1.0 in those aged 75 and over. Heavy manual work/DIY was a significant part of men's overall physical activity; 31% of men overall reported at least one occasion of this activity. Participation in this type of activity was lowest at the ends of the age range - 16% of men aged 16-24 and 17% of those aged 75 and over reported any manual work/DIY. Among men aged 25-74 the proportion who had done any manual work was fairly steady at around 35%. Women were much less likely to report having done any heavy manual work/DIY - only 12% overall; again lowest in the youngest and oldest age groups. There was a similar difference between men and women in the proportions reporting occupational activity. 22% of men overall were at least moderately active at work, compared with 12% of women. Among both men and women the proportion reporting occupational activity was fairly steady in those aged 16-54, falling slightly in those aged 55-64 and virtually disappearing in those aged 65 and over. Figure 5D shows the mean number of days'
participation in the main activity categories (heavy housework, sports
and exercise and walking) by men and women in the past four weeks.
Looking at the summary classification of participation in all types of activity, men overall were slightly more likely to have participated in physical activities than women (80% vs. 76%), and to have participated for a larger number of days (mean 13.7 among men, 11.0 among women). However this was not the case in all age groups. Among men, participation in physical activity was highest at 92% in those aged 16-34. Participation rates then fell steadily with age to 67% among men aged 65-74, with a sharp drop to 46% among men aged 75 and over. The mean number of days' participation similarly fell steadily from 19.7 days by men aged 16-24 to 8.2 days by those aged 65-74, with a sharper drop to 4.7 days in men aged 75 and over. Among women, participation in physical activity initially increased
from 85% of women aged 16-24 to 89% of those aged 25-34. Participation
then fell steadily to 76% among women aged 55-64, falling further to
31% in women aged 75 and over. The mean number of days' participation
remained fairly steady at around 13.5 in women aged 16-44, falling to
2.7 days in those aged 75 and over. 5.2.2 Time spent participating in different activities In addition to the number of days participating in each type of activity, informants were asked how long they had spent participating on each occasion. Table 5.2 shows the number of hours' participation in each type of activity per week, calculated by multiplying the number of days on which the activity was carried out by the average time per occasion, and converting to a weekly figure. Figures are shown separately for each activity type, and for the summary classification of all physical activities. For the summary classification, occupational activity is counted as 10 hours per week for full-time workers, 6 hours per week for part-time workers. Overall, 38% of men and 25% of women took part in physical activities for 7 hours or more per week, that is, at least one hour a day on average. Among men, the mean number of hours fell steadily with age, from 9.6 hours in men aged 16-24 to 6.5 in men aged 55-64 and 1.9 in those aged 75 and over. Among women the mean number of hours per week spent in physical activities
initially increased from 5.4 among those aged 16-24 to 6.2 among those
aged 35-44, before falling again to 4.4 among women aged 55-64 and 1.0
among those aged 75 and over. As with participation in activities overall,
the differential between men and women in the number of hours' participation
in physical activities grew less with increasing age. 5.2.3 Maximum intensity level attained Table 5.3 shows the maximum intensity level attained, by age and sex. This summary measure classifies informants according to the maximum intensity level reached in any type of activity in the four weeks prior to interview. In this measure, no account is taken of the frequency of the activity or of the duration, so that the overall proportions of men and women classified as active at a moderate level or higher are slightly higher than in the previous tables. In the last four weeks, the majority of men (81%) and women (78%) had participated in at least one occasion of moderate/vigorous activity (including some who had done so for less than 15 minutes only). Nearly a third of men (32%) and 22% of women had participated in activity at a vigorous level. For 12% of men and women the maximum intensity of activity reported was light activity; 10% of women and 7% of men reported no occasions of physical activity of at least light intensity. Among both men and women the proportion who had participated in vigorous activity fell steadily with age, from 67% (men) and 41% (women) among those aged 16-24, to 13% of men and women aged 55-64. The proportion of people aged 65 and over who had done any vigorous activity was very small. The proportion of men and women who were wholly inactive remained
at 5% or less in all age groups up to age 54, before increasing rapidly
with age: by age 75 and over a quarter of men and 39% of women reported
no occasions of activity of at least light intensity. However at the
other end of the activity scale significant proportions of those aged
75 and over were physically active: over a third of women (35%) and
nearly half of men (48%) in this age group had been active at a moderate
(or vigorous) level. 5.2.4 Physical activity at work All adults who were in paid employment or self-employed in the four weeks prior to interview were asked whether at work they were mainly sitting down, standing up or walking about; whether they did any climbing in the course of their work (excluding climbing stairs), and whether they had to lift or carry things at work that they found heavy. Answers to these questions are summarised in Table 5.4. Similar proportions of men (44%) and women (41%) said that when at work they were mainly walking about. Nearly half of men (49%) said that their work involved lifting and/or carrying heavy loads, as did 41% of women. Men were far more likely than women to say their work involved climbing (30% compared with 8%). Overall only 32% of men said that their work involved none of these
physical activities; 40% that it involved at least two of these. Fewer
women reported physical activities at work overall: 40% said that their
work involved none of these activities, and around a quarter that it
involved at least two. There was no consistent variation with age in
participation in these activities at work, except for lifting and/or
carrying heavy loads, which was most frequently reported by men and
women aged 16-24. 5.3 Overall levels of physical activity 5.3.1 Definitions of summary measures Frequency-intensity level of activity The frequency-intensity classification uses information available on the frequency and duration of activities as well as on the intensity of activity. This scale is similar to that used in the 1994 Health Survey report. The scale is intended to measure activity levels compared with the 'old' physical activity guidelines, which were that adults should take part in vigorous physical activities of 20 minutes' duration, three times a week. For this reason, only activities of a minimum duration of 20 minutes are included in this scale. For occupational activity, full-time workers are counted as 20 days in four weeks of activity, part-time workers as 12 days in four weeks. The classification is as follows:
Summary activity level Most analyses in this chapter use a revised summary activity level, which classifies informants according to the revised physical activity guidelines (which are that adults should take part in five or more occasions a week of activity of at least moderate intensity, of 30 minutes' or more duration). For the revised summary activity level, the minimum duration for all activities is 30 minutes. As before, full-time workers who were at least moderately active in their work are counted as 20 days' activity in the last four weeks, part-time workers as 12 days' activity. The summary activity level classification is as follows:
5.3.2 Participation in physical activities Frequency-intensity level of activity Table 5.5 shows the distributions for the 'old' frequency-intensity summary measure for men and women in different age groups. Perhaps the most striking finding here is the low proportion of adults who were active at Level 5, the level consistent with maximum cardiac benefit. Only in younger men did significant proportions report this level of activity. Overall 11% of men and 5% of women were active at Level 5. There was a steep decline with age in the proportions active at Level 5; among men this fell from 30% of men aged 16-24 to 8% of men aged 45-54. The decline among women with age was less steep, albeit from a lower peak: from 10% of women aged 16-24 to 4% of women aged 45-54. In both men and women aged 55 and over the proportions active at Level 5 were negligible. As seen in previous sections in this chapter, overall activity levels tended to decline with age, particularly among men. At age 16-24, 70% of men were active at Level 3 and above (that is, at least 3 occasions a week of moderate or vigorous activity of 20 minutes or more). This proportion fell steadily to 40% among men aged 55-64, falling further to 15% of men aged 75 and over. Among women aged 16-24 the proportion active at Level 3 and above
was much lower than for men in the same age group, at 46%. However this
proportion remained fairly level through to age 45-54 (45%), falling
to 34% among women aged 55-64, down to 8% among women aged 75 and over.
Thus the differential in activity levels between men and women was much
less marked from age 45 than for younger age groups. Summary activity level Table 5.7 shows the average number of days per week of participation
in 30 minutes or more moderate or vigorous activity by men and women,
and the summary activity level, by age group. Figure 5G shows proportions
of men and women in Group 1, Group 2 and Group 3 by age. Among men, over a third overall (37%) were classified in Group 3 (high activity). As seen for the other activity measures, this proportion fell steadily with age, from 58% of men aged 16-24 to 7% of those aged 75 and over. Among women, a quarter overall were classified in Group 3. As before this proportion was fairly level at 30-32% in women aged 16-54, before falling with age to 4% among women aged 75 and over. Group 3 is the level of activity that fulfils the current physical activity recommendations; Figure 5H illustrates the proportions of men and women achieving this level of activity. As the chart shows, up to age 44 men were more likely than women to
be classified in Group 3, that is, to meet the target activity level.
From age 45 and above the difference between men and women was much
less marked, as activity levels in both sexes declined rapidly with
advancing years. Combined activity classification As the two recommended guideline levels for physical activity are different, an informant who met one of the guideline levels would not necessarily meet the other. For example, someone who did only three bouts of vigorous activity of 20 minutes' duration per week would meet the 'old' guideline level (and indeed would be obtaining cardiac benefit from the activity), but would not meet the revised guideline level. Table 5.9 presents figures for the two classifications combined, that is, the proportions of people active at either, both or neither of the guideline levels. Overall far more men and women reached the revised guideline activity
level (ie 5 x 30 minutes moderate activity per week) than the old level
(ie 3 x 20 minutes vigorous activity per week). Most people who were
active at the old guideline level also met the revised guideline activity
level. Overall 40% of men and 26% of women met either or both of the
guideline activity levels. 5.3.3 Trends since 1994 Tables 5.6 and 5.8 show trends in the 'old' frequency-intensity activity classification, and in the 'new' summary activity level, since 1994. There were some differences in questions between the 1994 and 1998 surveys that affect the comparability of both these classifications. In the 1994 survey, information on the duration of home activities (ie housework and manual work/DIY) was not collected. Instead information was collected on the number of days' participation in these activities, lasting at least 15 minutes. In the summary classifications for 1994, all reported occurrences of housework and manual work/DIY are counted towards the total. This means that, for example, some occurrences of housework that lasted only 15 minutes will be included towards the total count, presented as activities lasting at least 20 minutes. In the 1998 survey, information on the duration of all activities was collected, so the summary classifications impose cut-offs on the duration of activities of 20 or 30 minutes. So some occurrences of housework or manual work/DIY that would have been counted in the summary variables in 1994 would not be counted in 1998. This means that the total number of occasions of reported moderate activity would be expected to be slightly higher in 1994 than in 1998. The number of occasions of vigorous activity are not affected, as home activities would never be counted as vigorous. Trends in frequency-intensity level There was no significant difference in the proportion of males and females active at Level 3 and above (that is, active at least three times a week). 49% of men in 1994 and 48% in 1998 were active at this level, as were 38% of women in both years. There were no significant differences in these proportions over time in the different age groups. The proportions of men and women in the lowest activity category,
Level 0 (i.e. no reported occasions of activity of at least 20 minutes'
duration) did appear to increase between 1994 and 1998 in both men (17%
in 1994, 23% in 1998) and women (19% in 1994, 26% in 1998). However
this is likely to be an artefactual consequence of the change in the
classification, noted above. That is to say, a proportion of those who
in 1994 were coded as activity Level 1 or 2 as a consequence of doing
15 minutes of housework or manual work/DIY, were coded as Level 0 in
1998. Trends in summary activity level Table 5.8 shows proportions of men and women in the summary activity level groups in 1994 and 1998. Group 3 on the summary activity level identifies those informants who met the current activity level, that is, took part in moderate or vigorous activities of at least 30 minutes' duration, on at least five days a week. The proportion of men in activity Group 3 was 37% in 1994, and remained at exactly this proportion in 1998. There were no significant differences in any age groups among men, except among the 16-24 group, where the proportion in Group 3 increased from 50% in 1994 to 58% in 1998. Among women the proportion meeting the guideline activity levels increased slightly, from 22% in 1994 to 25% in 1998. There were small increases in the proportion in Group 3 in all age groups up to age 54. As with the frequency-intensity scale, the proportion of men and women
in the lowest activity group (Group 1) appeared to increase between
1994 and 1998 (among men, from 30% to 35%; among women, from 35% to
41%). However it is likely that this increase was due to the changes
in the questionnaire in 1998. 5.4 Physical activity levels by socio-economic indicators 5.4.1 Components of activity and summary of activity levels by socio-economic indicators Social class and equivalised household income Participation in physical activities overall tended to increase with increasing household income, particularly among men. The age-standardised proportion of men who participated in any physical activities increased from 70% in the lowest income quintile to 86% and 85% in the two highest quintiles. Among women the age-standardised proportion who participated in any physical activity was 78% or 79% in the three higher income quintiles, but only 70% in the lowest quintile. The pattern according to social class was similar: among men, the age-standardised proportion participating was higher in Social Classes I and II; among women it was higher in Social Classes I, II and IIINM. Looking at participation in the different components of activity by income and social class, clearer patterns emerge. Among both men and women, participation in sports and exercise increased rapidly with increasing household income. The age-standardised proportion of men who took part in sports increased from 31% in the lowest household income quintile to 55% in the highest quintile; equivalent figures for women were 24% and 45%. A similar pattern was apparent in participation by social class; that is, rates of participation in sports and exercise tended to be higher in Social Classes I and II. Participation in walking was also strongly related to household income and social class, with men and women in higher income quintiles more likely to have participated in walking. Age-standardised proportions of men increased from 27% in the lowest income quintile to 41% in the highest; equivalent percentages for women were 19% and 30%. Similarly, proportions walking tended to be non-manual in the non-manual social classes. Participation in physical activity at work was, as might be expected,
strongly related to social class, particularly for men. In the manual
social classes around a third of men (age-standardised) participated
in occupational activity, more than twice the proportion in the non-manual
classes. Among women participation in occupational activity was particularly
high in Social Class V. In terms of household income, participation
in physical activity at work was highest in the middle income quintiles. Looking at the proportions of men and women in Group 3 of the summary activity level (that is, meeting the current physical activity guidelines), the pattern according to social class and income is less clear. Among men the age-standardised proportion in Group 3 was highest in Social Class V (50%), and lower in the non-manual social classes (31%-33% in Social Classes I, II and IIINM); the opposite pattern to that seen for participation in physical activities overall. This apparent discrepancy is due to the greater importance of occupational activity in the manual social classes, since informants who were physically active at work are automatically coded into the highest activity group. Similarly the age-standardised proportion of men in Group 3 was lower in the lowest (32%) and highest (34%) income quintiles than it was in the middle quintiles (40%-44%). Among women there was no clear pattern according to household income
or social class in the proportion in Group 3. Health Authority area type The overall rate of participation in physical activities was lowest in Inner London for both men and women, and tended to be lower in the more urban area types (Inner London, Mining and Industrial, Urban) than in the less urban areas (Mature, Prosperous and Rural), particularly for men. The age-standardised proportion of men participating in physical activity was 68% in Inner London, compared with 76%-78% in the other urban areas and 82% to 85% in the suburban/rural areas. Among women the lowest participation rate was in Inner London (70%), the highest in Rural areas (78%), but the gradient across area types was less clear. Looking at the types of activity, participation in housework was particularly low among men in Inner London (32% compared with 37%-39% in the other area types); among women participation in housework was lowest in Inner London (53%) and Mature and Prosperous area types (54%), and highest in Rural areas (62%). Participation in heavy manual work/DIY was also particularly low in Inner London (9% for men, compared with 35% in Rural areas). Participation in walking was lowest for both men and women in the
Mining and Industrial and Urban areas, and highest in Prosperous areas.
Participation in sports and exercise was highest in the Prosperous and
Mature area types. Looking at the summary activity level, the proportion of men in Group
3 was lower in Inner London (32% age-standardised) than in the other
area types (38%-40%). Among women the proportion in Group 3 did not
vary significantly by area type. 5.4.2 Logistic regression of participation in physical activities Separate logistic regressions were run for men and women, with the following independent variables: age group, social class of head of household, equivalised household income quintile, employment status and Health Authority area type. Six models were run (for each sex separately), with the dependent variables being participation in heavy housework, participation in heavy manual work/DIY, participation in walking, participation in sports and exercise, participation in physical activity at work, and participation in physical activity at activity Group 3. The odds ratios are presented in Tables 5.18 and 5.19, and are relative to average for each independent variable. An odds ratio of less than one means that the group was less likely to participate in the activity in question, and an odds ratio greater than one that the group was more likely. Independent variables with a 'p' value of 0.05 or less are significant predictors of the dependent variable at the 95% confidence level. The variations noted between sub-groups in participation in the different activity types, and in physical activities overall, tended to be confirmed in the regression models. For men, the odds of being in activity Group 3 were higher than average for those aged under 55 (particularly those aged 16-24), for those in the manual social classes, for those in the third and fourth income quintiles, and for those in employment. The lowest odds of being in activity Group 3 were for men aged 75 and over (0.20) or 65-74 (0.50), for men in Social Class I (0.59), and for the other economically inactive (0.47). Taking into account all the other independent variables, participation
in heavy housework was more likely among men aged 25-54 and among the
unemployed and retired. Men in the youngest (16-24) and oldest (75 and
over) age groups were less likely than average to participate in heavy
manual work/DIY, as were the other economically active and those living
in Inner London. The odds of participating in walking were higher for
men aged under 55 (particularly those aged 16-24), those in the non-manual
social classes, those in the two highest income quintiles, the unemployed
and retired, and those in Mature and Prosperous area types. Participation
in sports and exercise was more likely among men aged under 44 (particularly
those aged 16-24), those in Social Classes I and II, and those in the
top two income quintiles. The odds of participating in physical activity
at work were higher than average for men aged 16-24 and 55-64, for men
in the manual social classes, for those in the second and third income
quintiles, and (of course) for those in employment. For women, the odds of being in activity Group 3 were higher than average for those aged under 55 and for those in employment. Social class, household income and area type were not significant predictors of activity Group 3 for women. Taking into account all the other independent variables in the models,
participation in heavy housework was more likely than average among
women aged 25-64, those in Social Class IIINM, in the bottom income
quintile, among those in employment, and among those living in Urban
and Rural area types. The odds of women participating in heavy manual
work/DIY were higher among those aged 25-74, and in Prosperous and Rural
areas. Participation in walking was more likely in those aged under
55, those in non-manual social classes, those in the top income quintile,
the unemployed, and those living in Inner London and Prosperous areas.
For sports and exercise, the odds of participation were higher in those
aged under 55 (particularly those aged 16-34), the non-manual social
classes, the top two income quintiles, the unemployed, and those living
in Mature and Prosperous areas. The odds of women participating in physical
activity at work were higher in Social Classes IV and V, the bottom
three income quintiles, and those living in Urban and Mining and Industrial
areas.
References and notes 1 Saving Lives: Our Healthier Nation, The Stationery Office, London, 1999. 2 See for example The Health of the Nation. A strategy for health in England, HMSO, London, 1992; More people more active more often. Physical activity in England: A consultation paper. Department of Health, London, June 1995. 3 See for example Shaper AG and Wanamathee G. Physical activity and ischaemic heart disease in middle-aged British men, British Heart Journal 1991; 66:384-394; Powell KE, Thompson PD, Casperson CT et al. Physical activity and the incidence of coronary heart disease, Annual Review of Public Health 1987; 8:235-287. 4 See for example Helmrich SP et al. Physical activity and reduced occurrence of non-insulin-dependent diabetes mellitus, New England Journal of Medicine 1991; 325:147-152; Wolman R. Osteoporosis and exercise, British Medical Journal 1994; 309:400-403. 5 Killoran A et al (eds). Moving on: international perspectives on promoting physical activity, Health Education Authority, London, 1995. 6 American College of Sports Medicine. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults, Medicine and Science in Sports and Exercise 1990; 22:265-274. 7 Blair SN and Connelly JC. How much physical activity should we do? The case for moderate amounts and intensities of physical activity in Killoran A et al (eds) ibid. 8 Pate R R et al. Physical activity and public health: a recommendation from the Centres for Disease Control and Prevention and the American College of Sports Medicine, Journal of the American Medical Association 1995; 273:402-407. 9 Strategy statement on physical activity, Department of Health, London, 1996. 10 US Department of Health and Human Services. Physical activity and health: a report of the Surgeon General, Department of Health and Human Services, Centre for Disease Control and Prevention, National Centre for Chronic Disease Promotion and Health Promotion, Pittsburgh, 1996. 11 Gray R. Physical Activity in Colhoun H and Prescott-Clarke P (eds) Health Survey for England 1994, HMSO, London, 1994. 12 Prior G. Physical Activity in Prescott-Clarke P and Primatesta P (eds) Health Survey for England '95-'97, The Stationery Office, London, 1998. 13 Allied Dunbar National Fitness Survey, Health Education Authority and Sports Council, London, 1992. 14 Sports and exercise - Energy cost Vigorous: a) All occurrences of running/jogging, squash, boxing, kick boxing, skipping, trampolining. b) Sports coded as vigorous intensity if they had made the informant out of breath or sweaty, but otherwise coded as moderate intensity, including: cycling, aerobics, keep fit, gymnastics, dance for fitness, weight training, football, rugby, swimming, tennis, badminton. Moderate: a) See 'vigorous' category b). b) All occasions of a large number of activities including: basketball, canoeing, fencing, field athletics, hockey, ice skating, lacrosse, netball, roller skating, rowing, skiing, volleyball. c) Sports coded as moderate intensity if they had made the informant out of breath or sweaty, but otherwise coded as light intensity, including: exercise (press-ups, sit-ups), dancing. Light: a) See 'moderate' category c). b) All occasions of a large number of activities including: abseiling, baseball, bowls, cricket, croquet, darts, fishing, golf, riding, rounders, sailing, shooting, snooker, snorkelling, softball, table tennis, yoga. Examples of 'heavy' gardening or DIY work classified as moderate intensity: Digging, clearing rough ground, building in stone/bricklaying, mowing large areas with a hand mower, felling trees, chopping wood, mixing/laying concrete, moving heavy loads, refitting a kitchen or bathroom or any similar heavy manual work. Examples of 'heavy' housework classified as moderate intensity: Walking with heavy shopping for more than 5 minutes, moving heavy furniture, spring cleaning, scrubbing floors with a scrubbing brush, cleaning windows, or other similar heavy housework. Examples of 'light' gardening or DIY work classified as light intensity: Hoeing, weeding, pruning, mowing with a power mower, planting flowers/seeds, decorating, minor household repairs, car washing and polishing, car repairs and maintenance. Vigorous: Considers self very physically active in job and is in one of a small number of occupations defined as involving heavy work including: fishermen/women, furnace operators, rollermen, smiths and forge workers, faceworking coal-miners, other miners, construction workers and forestry workers. Moderate: Considers self very physically active in job and is not in occupation groups listed above OR considers self fairly physically active in job and is in one of a small number of occupations involving heavy or moderate work including: any listed above OR fire service officers, metal plate workers, shipwrights, riveters, steel erectors, benders, fitters, galvanisers, tin platers, dip platers, plasterers, roofers, glaziers, general building workers, road surfacers, stevedores, dockers, goods porters, refuse collectors. Light: Considers self fairly physically active in job and is not in one of the occupation groups listed above.
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