Editorial

Activity, Activity Restriction, and Sedentarism in Nursing Research

Biological Research for Nursing 2014, Vol 16(1) 5-6 ª The Author(s) 2013 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1099800413509878 brn.sagepub.com

Judith A. Maloni, PhD, RN, FAAN1, and Barbara A. Smith, RN, PhD, FACSM, FAAN2

Noncommunicable diseases (NCDs) such as cardiovascular diseases (CVDs), cancers, diabetes mellitus, and chronic respiratory diseases account for almost two thirds of global mortality, killing millions of people across the world (American College of Sports Medicine, 2011). The socioeconomic impact and years of productive life lost are staggering. In 2011, global leaders met at the United Nations to set a new international health agenda related to NCDs. In the resulting declaration, the United Nations proclaimed that inactivity was one of the leading risk factors for NCDs and called on world leaders and health professionals to develop a multifaceted plan to ameliorate such modifiable risk factors in order to decrease the mortality associated with NCDs (U.N. General Assembly, 2011). This call to action marked only the second time in its history that the U.N. General Assembly met to address a global health issue, with HIV/AIDS having served as the topic for the first such meeting. Prior to the 1940s, health care providers accepted the common wisdom that rest and reduced activity were of value in promoting health and recovery from illness. Decades of research by scientists who studied bed rest and physical activity, however, revealed that the function of almost every organ system is adversely affected by inactivity. The effects on the cardiovascular and musculoskeletal systems, in particular, rapidly lead to deconditioning and, eventually, to a decline in health status. As a result of this research, many providers now encourage early ambulation after illness or medical procedures for the elderly, for surgical patients, and for other hospitalized or institutionalized patients and are beginning to encourage it even in intensive care units. In spite of the evidence, however, health care providers often continue to restrict activity for a variety of reasons, such as to prevent falls and, unfortunately, sometimes to assure convenient provider access to patients. Of concern also is the increasingly sedentary lifestyle many healthy individuals are adopting due to changes in work and leisure environments. Aerobic and resistance or strengthening exercises have both physical and psychosocial benefits including improved cardiac and metabolic indicators and reduced perceptions of fatigue, depression, and anxiety. Such exercise can also help prevent osteoporosis, improve lipid levels, manage weight, reduce falls, and improve quality of life. However, a large percentage of the

population does not engage in moderate-to-vigorous physical activity on a regular basis. In addition, many health care providers, including nurses, often lack knowledge about the type and amount of physical activity necessary to achieve specific outcomes such as improved fitness, enhanced bone health, or a healthy body weight, which is associated with reduced risks of diabetes, high blood pressure, heart disease, stroke, and several types of cancer as well as premature mortality. The overall goal of this special section, ‘‘Activity, Activity Restriction, and Sedentarism,’’ was to provide biobehavioral evidence of the effectiveness of interventions or alterations in care that increase appropriate physical activity or reduce sedentarism in healthy and acutely or chronically ill populations. Furthermore, we wanted to publish research examining the unintended consequences of immobility and/or activity restriction that result from acute and chronic disease processes and their treatments. The six articles we selected provide examples of the latest nursing research exploring the full continuum of activity levels, from sedentarism through moderate-to-vigorous exercise. Of these six, four are related to inactivity, with two documenting the decline in physical status when activity is restricted, one describing the correlates of decline in physical activity, and the final article exploring the changes in physical activity levels following a medical procedure. In their article, Mottola and colleagues describe a study in which they identified the detrimental effects of inactivity upon a biomarker of bone resorption when women have been prescribed antepartum bed rest. Their findings lead them to express concern for the effect of bed rest treatment on lifelong maternal bone health. Moes and colleagues examined the effects of neuropathic pain upon activity and muscle mass using an animal model. Their results

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Frances Payne Bolton School of Nursing, Case Western Reserve University, Chagrin Falls, OH, USA 2 College of Nursing, Michigan State University, East Lansing, MI, USA Corresponding Author: Judith A Maloni, PhD, RN, FAAN, Frances Payne Bolton School of Nursing, Case Western Reserve University, 101 Foxhall Drive, Chagrin Falls, OH 44022, USA. Email: [email protected]; [email protected]

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indicate that such pain is accompanied by a decrease in activity and an increase in skeletal muscle atrophy. Leutwyler and colleagues’ study provides insight into factors that contribute to low physical activity among older individuals with schizophrenia. They found that individuals with more severe schizophrenia symptoms and neurocognitive deficits were significantly more likely to have lower levels of physical activity. Finally, Sherry and colleagues describe improvement in physical activity among individuals with heart failure who undergo cardiac resynchronization therapy, reporting that patients’ activity and physical function increased and physical symptoms improved postsynchronization. In the remaining two studies, the authors examine the effects of exercise on general health. Because women are significantly more likely to die from CVD than from other diseases, Bartfay and colleagues compared health outcomes for two groups of postmenopausal women: those who were sedentary and those who engaged in moderate forms of exercise at least 3 times a week. Exercisers demonstrated higher levels of red cell activity, less oxidative stress, and lower body-iron burden, suggesting that exercise may alter women’s risk for CVD. Finally, in their exercise intervention study, Faulkner and colleagues examined adherence to a community-based personal fitness

exercise program among groups of adolescents who had either type 1 or type 2 diabetes mellitus or who were obese. Health outcomes improved significantly in both groups despite the fact that the exercise intervention did not meet today’s standards for duration of daily moderate-to-vigorous physical activity. We hope this special section will stimulate nurse–scientists to conduct robust studies exploring the broad range of physical activity in which people engage in both health and illness. Such studies are crucial for providing solid and specific evidence to guide nurse–clinicians and other health care providers as they seek to help patients improve their health and prevent NCDs by increasing or modifying their physical activity. References American College of Sports Medicine. (2011, September 20). Historic success: U.N. approves global campaign against NCDs, puts strong focus on physical activity. Sports Medicine Bulletin. Retrieved from http://multibriefs.com/briefs/acsm/ACSM092011.php U.N. General Assembly. (2011, September 16). Political declaration of the High-Level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. Retrieved from http:// www.un.org/ga/search/view_doc.asp?symbol¼A%2F66%2FL.1&L ang¼E

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