Commentary to Accompany
Physical inactivity and sedentary living contribute substantially to a global public health burden (3). Indeed, recent estimates indicate that over 30% of the world’s adult population do not meet the World Health Organization’s recommendation for physical activity (150 min or more of moderate-intensity activity per week) (2), and this estimate of inactivity probably is higher in older (≥65 yr) people. Most supervised physical activity interventions result in improvements in nearly every risk factor relating to common chronic conditions of older age; however, these benefits dissipate soon after the formal intervention period, as adherence to a structured exercise program tends to wane.
This issue of Exercise and Sport Sciences Reviews presents a review of a relatively simple home-based intervention comprising an interval walking training (IWT) program that uses a small portable calorimeter linked to an information technology (IT) network, the e-Health Promotion System (4). Participants download their training data from the portable calorimeter every 2 wk to a server within a community health care institute, a pharmacy, or community office and then receive a graphical printout of their achievements. This novel intervention seems to combine the best of the laboratory with that of community-based research. Indeed, Masuki et al. provide evidence of both the short- and long-term effectiveness of this program on improvements in cardiorespiratory fitness and lifestyle-related disease risk in large samples of Japanese adults. Notably, adherence to the IWT program over 4 months was 100% and over 22 months was 70% in the older participants and was correlated significantly with training-related improvements in fitness and disease risk.
The potency of low-volume, high-intensity interval training (HIT) for stimulating positive adaptations in skeletal muscle, cardiorespiratory fitness, and lower disease risk has been established (1); yet HIT has not achieved its full potential among older people, presumably because of safety concerns. The IWT program described by Masuki, et al., is based on walking, with a 40% peak aerobic capacity (V˙O2peak)/70% V˙O2peak interval split. In an older person with a V˙O2peak of 25 mL·kg−1·min−1, this intensity translates to approximately 2.8 METs/5 METs, which is easily accomplished in 3-min intervals by healthy older people, but may be considered by some to be of moderate intensity, rather than of high intensity. Nonetheless, the most promising aspect of IWT from a public health perspective is that the time required to achieve its benefits is far less than that of high-volume, sustained, moderate-intensity endurance exercise, thereby eliminating a frequently cited barrier to performing regular physical activity among adults. Moreover, the IWT program described here promotes several psychosocial attributes that can increase adherence to regular unsupervised exercise among older people — namely: 1) increased feelings of self-efficacy and reward from frequent feedback on their progress from the e-health link; 2) competition among participants, because progress can be shared on a common social media platform; and 3) social support among a local e-health community.
Thus, we now have a promising intervention for increasing community-level physical activity in older people that combines the best physiological evidence from exercise training studies with the most innovative behavioral technology to enhance its public health impact. Not only does the IWT program extend the reach of supervised laboratory-based exercise out to the community via the IT link, its e-Health Promotion System could be connected to electronic health records, thereby providing clinicians with the ability to track physical activity patterns over many years. In sum, this novel IWT program presents an excellent model of a multiple-sector (i.e., science, technology, and health care) approach to health promotion that could improve our ability to move the needle away from our current levels of physical inactivity toward a more active global community.
Department of Exercise & Nutrition Sciences
Milken Institute School of Public Health
George Washington University
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