The treatment of noncommunicable diseases (NCD), like coronary heart disease or type 2 diabetes mellitus, causes rising costs for the health system. Physical activity is supposed to reduce the risk for these diseases. Results of cross-sectional studies showed that physical activity is associated with better health, and that physical activity could prevent the development of these diseases. The purpose of this review is to summarize existing evidence for the long-term (>5 years) relationship between physical activity and weight gain, obesity, coronary heart disease, type 2 diabetes mellitus, Alzheimer’s disease and dementia. Fifteen longitudinal studies with at least 5-year follow up times and a total of 288,724 subjects (>500 participants in each study), aged between 18 and 85 years, were identified using digital databases. Only studies published in English, about healthy adults at baseline, intentional physical activity and the listed NCDs were included. The results of these studies show that physical activity appears to have a positive long-term influence on all selected diseases. This review revealed a paucity of long-term studies on the relationship between physical activity and the incidence of NCD.

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Long-term health benefits of physical activity – a systematic review of longitudinal studies

Background 
Although from a societal point of view a modal shift from car to bicycle may have beneficial health effects due to decreased air pollution emissions, decreased greenhouse gas emissions, and increased levels of physical activity, shifts in individual adverse health effects such as higher exposure to air pollution and risk of a traffic accident may prevail.

Do the Health Benefits of Cycling Outweigh the Risks

Health impact assessment of active transportation: A systematic review

PURPOSE OF THE STUDY: There is a global imperative to increase awareness of the emerging evidence on physical activity (PA) among older adults. "Healthy aging" has traditionally focused on preventing chronic disease, but greater efforts are required to reduce frailty and dependency and to maintain independent physical and cognitive function and mental health and well-being. DESIGN AND METHODS: This integrated review updates the epidemiological data on PA, summarizes the existing evidence-based PA guidelines, describes the global magnitude of inactivity, and finally describes the rationale for action. The first section updates the epidemiological evidence for reduced cardiometabolic risk, reduced risks of falls, the burgeoning new evidence on improved cognitive function and functional capacity, and reduced risk of depression, anxiety, and dementia. This is followed by a summary of population prevalence studies among older adults. Finally, we present a "review of reviews" of PA interventions delivered from community or population settings, followed by a consideration of interventions among the "oldest-old," where efforts are needed to increase resistance (strength) training and balance. RESULTS: This review identifies the global importance of considering "active aging" beyond the established benefits attributed to noncommunicable disease prevention alone. IMPLICATIONS: Innovative population-level efforts are required to address physical inactivity, prevent loss of muscle strength, and maintain balance in older adults. Specific investment in healthy aging requires global policy support from the World Health Organization and is implemented at the national and regional levels, in order to reduce the burden of disease and disability among older adults.© The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. Language: en

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Updating the evidence for physical activity: summative reviews of the epidemiological evidence, prevalence, and interventions to promote "active aging"

Relationship between the physical environment and physical activity in older adults: A systematic review

As the number of elderly persons in our country increases, more attention is being given to geriatric healthcare needs and successful ageing is becoming an important topic in medical literature. Concept of successful ageing is in first line on a preventive approach of care for older people. Promotion of regular physical activity is one of the main non-pharmaceutical measures proposed to older subjects as low rate of physical activity is frequently noticed in this age group. Moderate but regular physical activity is associated with a reduction in total mortality among older people, a positive effect on primary prevention of coronary heart disease and a significant benefit on the lipid profile. Improving body composition with a reduction in fat mass, reducing blood pressure and prevention of stroke, as well as type 2 diabetes, are also well established. Prevention of some cancers (especially that of breast and colon), increasing bone density and prevention of falls are also reported. Moreover, some longitudinal studies suggest that physical activity is linked to a reduced risk of developing dementia and Alzheimer's disease in particular.

Health benefits of physical activity in older patients: a review

Though different in many respects from other types of services, health care services are also impacted by globalization. For example, some countries, especially developing ones, can attract customers by offering high quality health care at a lower cost than is available in their home country. And although this practice is relatively uncommon at the present time, our hypothesis is that, within a short time, this practice will greatly expand, partly due to the development of global standards of quality and the rise of processes of accreditation, both in health care and medical education.

Globalization is characterized by the circulation of goods and services between countries in response to criteria of efficiency. Such multilateral agreements between countries, unfortunately, often function to the detriment of the countries with less developed economies. Nevertheless, trade can also benefit developing countries. Outsourcing is one situation in which developing countries that are able to adopt standards, processes, and language of developed countries can benefit from the liberalization of the movement of goods and services. By undertaking some or all components of production or service provision for clients/consumers in the developed country, some economic benefits may occur to the developing country where the ‘outsourced’ service is provided.

But what, we might ask, is the impact of the process of globalization generally and outsourcing more particularly in the health care sector?

The movement of professionals in general tends to be detrimental to poorer countries. There are two aspects to this. The most classic is the settlement of young professionals, originally from …

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Globalization in health care: is international standardization of quality a step toward outsourcing?

Summary

Background: Ageing is known to be associated with a decrease in peak oxygen consumption (VO2peak) and maximal tolerated power (MTP). Regular physical exercise is the most appropriate to improve aerobic capacity, but its effect still remained discussed in old people.



Design:  The aim of this study was to determine whether a short interval training session would be associated with improvements in exercise efficiency in aged subjects in both genders.



Methods:  In all, 19 women and 16 men (65.4 ± 4.9 years) performed a cycle incremental exercise test before and after a 9-week period of aerobic interval training (twice a week, 30 min session where 6 × 4-min at the first ventilatory threshold alternated with 1-min at the second ventilatory threshold) with cycle ergometer. Minute ventilation (MV), O2 uptake (VO2) and CO2 output (VCO2) were measured breath-by-breath and by an open-circuit metabolic cart.



Results:  Before training, maximal values of MV (MMV), VO2peak, heart rate, systolic blood pressure, MTP, blood lactate at MTP recovery and the power at the first (pVT1) and second ventilatory thresholds (pVT2) were higher in men compared with women. Nine weeks of interval training induced a significant increase in MMV, VO2peak, MTP, pVT1 and pVT2 and decrease in systolic blood pressure in the same way in men than in women, without any significant effect on their maximal heart rate values.



Conclusions:  These findings suggest that the age-related declines in aerobic index are attenuated by a short exercise interval training sessions in women and men.

Impact of short‐term aerobic interval training on maximal exercise in sedentary aged subjects

CONTEXT The last 10 years have represented a period of significant reform within both the health care and education systems in France. In terms of its workforce, France faces a shortage of doctors, particularly in primary care. METHODS This paper examines the French medical curriculum, student selection, licensure and continuing medical education and discusses the challenges currently facing French medical faculties. RESULTS The French medical curriculum is defined nationally, with methods adapted at medical school level. There has been some uptake of innovative methods such as problem-based learning, skills-based teaching and performance-based assessment. However, traditional didactic teaching of scientific medicine and the apprenticeship model remain dominant. France uses a unique method of selection, which is the subject of much debate. Following a general year, medical students are subject to a selection examination that permits only a small number to continue studies. Similarly, at the end of medical school, a written test is used to rank students for the purpose of matching to specialty training. France has no national colleges or licensing authorities and thus authorisation to practise rests on the diploma delivered by each faculty of medicine. From 2005, continuing medical education became compulsory for all doctors. It includes the evaluation of medical practice. CONCLUSIONS French faculties of medicine face several challenges, including: rising numbers of students without a commensurate growth in the number of faculty members; an increasing emphasis on multidisciplinary health care; a drive towards mandatory continuing education and performance-based outcomes, and the development of national selection examinations that are knowledge-based.

Country report: medical education in France.

The aim of this study was to evaluate the efficiency of a short-term Intermittent Work Exercise Program (IWEP) among healthy elderly subjects. This longitudinal prospective study took place at the Strasbourg University Hospital geriatric department. One hundred and fifty older volunteers, previously determined as being free from cardiac and pulmonary disease, were separated into two age groups: the “young senior” (60.2 ± 3.1 yr) and the “older senior” groups (70.8 ± 5.2 yr).These groups were then subdivided by gender into the “young female senior”, “young male senior” “older female senior” and “older male senior” groups. Before and after the IWEP, all subjects were asked to perform an incremental cycle exercise to obtain their first ventilatory threshold (VT1), maximal tolerated power (MTP), peak oxygen uptake (VO2peak) and maximal minute ventilation (MMV). The IWEP consisted of a 30-min cycling exercise which took place twice a week, and was divided into six 5-min stages consisting of 4 min at VT1 intensity and 1 min at 90% MTP. An assessment was made of the effects of the IWEP on maximal cardio-respiratory function (MTP, VO2peak, MMV) and endurance parameters (VT1, heart rate [HR] measured at pretraining VT1 and lactate concentrations at pre-training MTP). This short-term training program resulted in a significant increase of MTP (from 13.2% to 20.6%), VO2peak (from 8.9% to 16.6%) and MMV (from 11.1% to 21.8%) in all groups (p 0.05) from the “young seniors” pre-training values for the same parameters. The most striking finding in this study is that after only 9 weeks, our short-term “individually-tailored” IWEP significantly improved both maximal cardio-respiratory function and endurance parameters in healthy, previously untrained seniors.

Effects of a short-term personalized intermittent work exercise program (IWEP) on maximal cardio-respiratory function and endurance parameters among healthy young and older seniors

Pierre-Henri Bréchat

Papers

Health benefits of physical activity in older patients: a review

Globalization in health care: is international standardization of quality a step toward outsourcing?

Impact of short‐term aerobic interval training on maximal exercise in sedentary aged subjects

Country report: medical education in France.

Effects of a short-term personalized intermittent work exercise program (IWEP) on maximal cardio-respiratory function and endurance parameters among healthy young and older seniors