Chapter 01
Origins of Physical Activity
Epidemiology
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
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
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
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
Exercise as Medicine
Ayurveda System of Medicine, 9th
Century 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.
• Sushruta also recognized physical activity as
preventive medicine, viewing sedentary living as a
cause of obesity, diabetes, and early death
Origins of Physical Activity Epidemiology
Exercise as Medicine
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
Origins of Physical Activity Epidemiology
Exercise as Medicine
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”
Origins of Physical Activity Epidemiology
Exercise as Medicine
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.
Origins of Physical Activity Epidemiology
Exercise as Medicine
Middle Ages
The work Sirr al-asrar, reportedly written
by Aristotle, is believed to be the basis of
the famous poem of medicine, Regimen
Sanitatis Salernitanum, 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
Exercise as Medicine
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)
Origins of Physical Activity Epidemiology
Exercise as Medicine
Revival of Physical Education, Renaissance
Period
• Leon Battista Alberti recommended 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.
Origins of Physical Activity Epidemiology
Exercise as Medicine
Revival of Physical Education, Renaissance
Period
•Maffeus Vegius, 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 not embrace
exercise. This was changed during the Renaissance
by the Italian physician Hieronymus Mercurialis.
(see next slide)
Origins of Physical Activity Epidemiology
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
Revival of Physical Education, Renaissance
Period
Hieronymus Mercurialis
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.
Origins of Physical Activity Epidemiology
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
Exercise as Medicine
Revival of Physical Education, Renaissance
Period
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
Ars Medica Hermetica, “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
Exercise as Medicine
Age of Enlightenment to the Modern Era
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
Exercise as Medicine
Age of Enlightenment to the Modern Era
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
Exercise as Medicine
Age of Enlightenment to the Modern Era
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
Exercise as Medicine
Age of Enlightenment to the Modern Era
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
Exercise as Medicine
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.
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
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
Exercise as Medicine
Age of Enlightenment to the
Modern Era
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
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
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
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
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
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
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
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
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
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:
1) Reduce risk factors for chronic diseases that
stem from unhealthy diets and physical
inactivity through public health actions.
2) 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
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
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
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