ReviewPhysical activity level and health-related quality of life in the general adult population: A systematic review
Introduction
Sedentary lifestyle increases the risk of developing many health conditions particularly cardiovascular diseases, hypertension, type 2 diabetes mellitus, colon and breast cancers, osteoporosis, depression, and backaches (U.S. Department of Health and Human Services, 1996, Morrow et al., 1999, Oja and Borms, 2004). Although many observational and experimental studies have demonstrated the benefit of increased physical activity (PA) in reducing chronic diseases in the general adult population (Hambrecht et al., 2004, Helmrich et al., 1994, Hoidrup et al., 2001, Hu et al., 2005, Laaksonen et al., 2005, McTiernan et al., 2003, Schnohr et al., 2003, Whelton et al., 2002), little is known however, regarding the association between health-related quality of life (HRQL), and physical activity (PA) level in this population.
Most conceptualizations of HRQL include physical, mental (including emotional dimensions), and social components (Revicki, 1989). HRQL encompasses the perceived, valued health attributes such as the sense of comfort or well-being, the ability to maintain good physical, emotional, and intellectual functions, and the ability to satisfactorily take part in social activities.
Research on HRQL in the PA domain has predominately been focused on elder populations with chronic conditions (e.g., cardiovascular diseases, arthritis, pulmonary diseases, and cancer). In their review on PA (including fitness level) and HRQL, Rejeski et al. (1996) report chronically diseased populations tend to improve their HRQL from increased PA. Courneya and Friedenreich (1999) found physical exercise consistently had a positive effect on HRQL following cancer diagnosis in their review of 24 (mainly preliminary efficacy) studies. Although it appears no systematic review among diabetic patients has been conducted, some studies have shown a positive association between HRQL and PA level in this population (Chyun et al., 2006, Maddigan et al., 2005, Smith and McFall, 2005).
Older adults and those with chronic diseases present with specific HRQL profiles and have specific challenges and needs. For example, the elderly typically report poorer physical health than the younger population (and worse physical health than their mental health), and lack physical strength and balance (Hopman et al., 2000). Further, chronic disease groups, which consist of predominately older individuals in our populations, require tailored PA recommendations according to their disease status (Agency for Healthcare Research and Quality and the Centers for Disease Control, 2002, Centers for Disease Control and Prevention, 2007). The relationship between PA and HRQL reported in these population groups therefore may not be generalizable to younger, disease-free populations.
Moreover, the demonstration of a positive association between PA level and HRQL could provide healthy adults with a motivation to become more physically active, more so than the distal perspective of decreasing the risk for chronic diseases — especially when there is a general tendency for individuals to underestimate their health-related risks (Weinstein, 1989). In the field of health behavior change the need for finding alternative motivational strategies than those based on risk awareness is warranted. As advocated by Rose (1992), such public health approaches also represent a meaningful complement to strategies targeting high-risk populations.
Although the current literature examining the association between PA level and HRQL in the younger (< 65 years of age), general adult population appears to be limited, a review of the studies on this population investigating this relationship is warranted. Our objective was to systematically review and analyze data examining the relationship between PA level (or aerobic fitness) and HRQL (or perceived health) among healthy subjects from the general adult population under 65 years of age.
Section snippets
Criteria for considering studies for this review
Eligible studies included those exploring HRQL in relation with PA among the general population (as opposed to clinical populations with specific chronic medical conditions). Eligible participants consisted of healthy adults (aged 15 or older) drawn from the general population who participated in studies related to PA. Studies specifically targeting older adults (≥ 65 years of age) were excluded. Studies examining aerobic fitness were also considered for inclusion. Aerobic fitness is a
Description of studies
Fig. 1 describes the progress through the stages of study selection. The electronic search strategy provided 1426 references. Based on titles and abstracts, 35 references were judged to require further evaluation (Andrijasevic et al., 2005, Annesi, 2002, Artazcoz et al., 2004, Ashley et al., 2001, Aurilio, 2000, Baiardi et al., 2005, Behmer et al., 1993, Berra, 2003, Daskapan et al., 2005, Fody-Urias et al., 2001, Fox, 1999, Hatziandreu et al., 1988, Hiraoka et al., 1998, Hyland et al., 1999,
Discussion
To our knowledge, this systematic review is the first synthesis on the association between PA and HRQL in the general adult population. When reviewing cross-sectional evidence, higher PA levels were consistently associated with higher/better scores in various HRQL dimensions. The association between HRQL and PA however varies across HRQL dimensions, with higher physical functioning and vitality being more consistently associated with higher PA levels. This association remained after potential
Conclusions
There appears to be a consistent association of higher HRQL scores with higher PA levels among apparently healthy adults in cross-sectional studies. These data will hopefully encourage researchers to improve the methods of this field, particularly by applying ‘state of the art’ PA measures and developing more responsive HRQL instruments. Further evidence regarding HRQL benefits of regular PA among the general population would support the role and importance of PA beyond chronic disease
Acknowledgments
The authors would like to thank Cindy Forbes for her independent screening of the citations and her contribution to the selection of relevant studies, and Kylie Hugo, Erin Buhr and Nandini Karunamuni for their helpful comments on a previous draft of this manuscript. There are no known potential conflicts of interest. External sources of support are as follows: Raphaël Bize holds salary support from The Swiss National Science Foundation; Jeffrey Johnson holds a Canada Research Chair in Diabetes
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