Indicators proposed for the European Health Monitoring System

Physical activity and Health-related fitness have been proposed as indicators for the European Health Monitoring System. Their descriptions below are taken from ‘Making way for a healthier lifestyle in Europe’, the summary report of the project ‘Monitoring Public Health Nutrition in Europe’ (Sjöström et al., 2003).

Indicator: Physical Activity Level and Pattern

Suggested operational measures for this indicator:

• Total amount of activity expressed either as activity energy expenditure (kcal, Joules, MET mins, etc) or physical activity level (PAL);
• PAL: Time (mins/day or week) spent at health enhancing physical activity level (i.e. activity at moderate and vigorous intensity levels);
• Time (mins/day or week) spent sitting;

Justification for this indicator: Physical activity is a complex behaviour. Any activity can be described in terms such as intensity, frequency and duration, and these dimensions must be considered. An assessment methodology should also consider inactivity, such as time spent sitting. Physical activity can be related to work, transportation, home and leisure time. The activities at either of these domains may have specific health consequences, and advanced monitoring should also consider these.

Indicator: Health-related Fitness

This concept can be operationalized in different ways. Physical fitness can be thought of as an integrated measure of most, if not all body functions (musculoskeletal, cardiorespiratory, circulatory, psychoneurological, endocrine-metabolic) involved in the performance of daily physical activity and/or physical exercise. Hence, when physical fitness is tested, the functional status of all these systems is actually being checked. Health-related physical fitness, refers to those components of fitness that are affected favorably or unfavorably by physical activity habits and relate to health status (Ruiz et al., 2006b).

Operationalization: Maximal Aerobic Capacity. This can be done by the 2km UKK Walk Test as a population assessment of cardiovascular fitness (aerobic fitness/maximal aerobic power) and is named as the golden standard.

Justification for this indicator: It is well suited for the assessment of health-related fitness among the general population. It also reflects the functional capacity of the musculo-skeletal system.

Operationalizations: Bodily Control, Muscular Strength, Joint Mobility. Tests to measure these fitness components have been defined within the EUROFIT project. A new consensus test battery is in development by the ALPHA project.

Justification for monitoring muscular strength:The role of muscular strength in the performance of activities of daily living and exercise, as well as in the prevention of chronic disease is increasingly being recognized. Resistance exercise training increases muscular strength, and is currently prescribed by major health organizations for improving health and fitness. It provides strong and independent prognostic information about the overall risk of illness and death in both men and women across a broad spectrum of ages.