https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(08)61690-6.pdf

Closing the gap in a generation: health equity through action on the social determinants of health

The purpose of this Position Stand is to provide an overview of issues critical to understanding the importance of exercise and physical activity in older adult populations. The Position Stand is divided into three sections: Section 1 briefly reviews the structural and functional changes that characterize normal human aging, Section 2 considers the extent to which exercise and physical activity can influence the aging process, and Section 3 summarizes the benefits of both long-term exercise and physical activity and shorter-duration exercise programs on health and functional capacity. Although no amount of physical activity can stop the biological aging process, there is evidence that regular exercise can minimize the physiological effects of an otherwise sedentary lifestyle and increase active life expectancy by limiting the development and progression of chronic disease and disabling conditions. There is also emerging evidence for significant psychological and cognitive benefits accruing from regular exercise participation by older adults. Ideally, exercise prescription for older adults should include aerobic exercise, muscle strengthening exercises, and flexibility exercises. The evidence reviewed in this Position Stand is generally consistent with prior American College of Sports Medicine statements on the types and amounts of physical activity recommended for older adults as well as the recently published 2008 Physical Activity Guidelines for Americans. All older adults should engage in regular physical activity and avoid an inactive lifestyle.

Exercise and physical activity for older adults

The brain is the key organ of the response to stress because it determines what is threatening and, therefore, potentially stressful, as well as the physiological and behavioral responses which can be either adaptive or damaging. Stress involves two-way communication between the brain and the cardiovascular, immune, and other systems via neural and endocrine mechanisms. Beyond the "flight-or-fight" response to acute stress, there are events in daily life that produce a type of chronic stress and lead over time to wear and tear on the body ("allostatic load"). Yet, hormones associated with stress protect the body in the short-run and promote adaptation ("allostasis"). The brain is a target of stress, and the hippocampus was the first brain region, besides the hypothalamus, to be recognized as a target of glucocorticoids. Stress and stress hormones produce both adaptive and maladaptive effects on this brain region throughout the life course. Early life events influence life-long patterns of emotionality and stress responsiveness and alter the rate of brain and body aging. The hippocampus, amygdala, and prefrontal cortex undergo stress-induced structural remodeling, which alters behavioral and physiological responses. As an adjunct to pharmaceutical therapy, social and behavioral interventions such as regular physical activity and social support reduce the chronic stress burden and benefit brain and body health and resilience.

/pdf/physiology-and-neurobiology-of-stress-and-adaptation-central-2xtqi7pnfe.pdf

Physiology and Neurobiology of Stress and Adaptation: Central Role of the Brain

Social entrepreneurship, as a practice and a field for scholarly investigation, provides a unique opportunity to challenge, question, and rethink concepts and assumptions from different fields of management and business research. This paper puts forward a view of social entrepreneurship as a process that catalyzes social change and/or addresses important social needs in a way that is not dominated by direct financial benefits for the entrepreneurs. Social entrepreneurship is seen as differing from other forms of entrepreneurship in the relatively higher priority given to promoting social value and development versus capturing economic value. To stimulate future research the authors introduce the concept of embeddedness as a nexus between theoretical perspectives for the study of social entrepreneurship. Different research methodologies and their implications are discussed.

https://papers.ssrn.com/sol3/Delivery.cfm/SSRN_ID984426_code361123.pdf?abstractid=673446&mirid=1&type=2

Social Entrepreneurship Reserach: a Source of Explanation, Prediction and Delight

▪ Abstract The thesis of this article is that multilevel interventions based on ecological models and targeting individuals, social environments, physical environments, and policies must be implemented to achieve population change in physical activity. A model is proposed that identifies potential environmental and policy influences on four domains of active living: recreation, transport, occupation, and household. Multilevel research and interventions require multiple disciplines to combine concepts and methods to create new transdisciplinary approaches. The contributions being made by a broad range of disciplines are summarized. Research to date supports a conclusion that there are multiple levels of influence on physical activity, and the active living domains are associated with different environmental variables. Continued research is needed to provide detailed findings that can inform improved designs of communities, transportation systems, and recreation facilities. Collaborations with policy resear...

https://www.annualreviews.org/doi/pdf/10.1146/annurev.publhealth.27.021405.102100

An ecological approach to creating active living communities.

Understanding childrens' health behaviour: the implications for health promotion for young people.

Social Entrepreneurs are Vital for Health Promotion—But They Need Supportive Environments Too

Accepted for publication November 1989 The quality of evaluation in health education has been an important obstacle to better interventions, and wider acknowledgement of the importance of health education in improving public health. In the past, the urgency of immediate health problems, the practical orientation of health educators, and the complex nature of evaluation in health education have usually meant that interventions were established on the basis of limited research, and with little or no consideration given to the need to evaluate. Progress in evaluation has been painfully slow. In the past two decades greater attention has been given to the need to evaluate, particularly in the United States, and there has been a corresponding development in the quality and range of examples of well evaluated health education projects and programmes. This paper has been developed on a review of the growing literature on the subject of evaluation in health education, and illustrates key issues with examples from a range of evaluated programmes. A framework for evaluating health education programmes is proposed and suggestions are made for improved health education research.

Evaluation in health education. A review of progress, possibilities, and problems.

Objective: To assess the net 5 year effects of intervention of a community based demonstration project, the Heartbeat Wales programme, on modifiable behavioural risks for prevention of cardiovascular disease. Design and setting: Quasi-experimental design comparing results from two independent cross sectional population surveys conducted in 1985 and 1990 in Wales and a matched reference area in north east England. Subjects: Random, stratified samples of people aged 18-64 years (18 538 in 1985 and 13 045 in 1990) in Wales and in north east England (1483 and 4534, respectively). Intervention: A coordinated range of activities for heart health promotion in Wales entailing public education campaigns along with supportive policy and infrastructure change. In the reference area no additional community heart health promotion was planned, though considerable activity did take place, “contaminating” the reference area. Main outcome measures: Fifteen self reported behavioural indicators relating to dietary choice, smoking, frequency of exercise, and weight. Results: Positive changes (for health) in behavioural outcomes were observed among the population in Wales, including a reduction in reported smoking prevalence and improvements in dietary choice. There was no net intervention effect for the programme over and above observed change in the reference area. Conclusions : No definite conclusions can be drawn concerning the efficacy of the programme in terms of behavioural outcomes. With hindsight, the difficulties of evaluating such a complex multifaceted intervention were underestimated. Further debate on the most appropriate methods for assessing the effectiveness of community based health promotion programmes is called for. Key messages Heartbeat Wales was set up in 1985 as a community based programme to demonstrate risk reduction for cardiovascular disease Important changes were observed in modifiable risks for cardiovascular disease in Wales between 1985 and 1990 There was an unexpectedly rapid uptake of heart health promotion activity in the reference area No net intervention effects were found for the programme over and above changes in the reference area Improvements in methods of evaluation for community based health promotion programmes are required

https://www.bmj.com/content/bmj/316/7134/818.full.pdf

Effects of the Heartbeat Wales programme over five years on behavioural risks for cardiovascular disease: quasi-experimental comparison of results from Wales and a matched reference area

/pdf/illicit-drugs-effective-prevention-requires-a-health-4y28as9hq3.pdf

John Catford

Papers

Understanding childrens' health behaviour: the implications for health promotion for young people.

Social Entrepreneurs are Vital for Health Promotion—But They Need Supportive Environments Too

Evaluation in health education. A review of progress, possibilities, and problems.

Effects of the Heartbeat Wales programme over five years on behavioural risks for cardiovascular disease: quasi-experimental comparison of results from Wales and a matched reference area

Illicit drugs: effective prevention requires a health promotion approach.