Essay on Determinant of Health
Number of words: 2552
Global burden of ill health from chronic diseases is disproportionately mapped across geographical regions and populations. This inequality can be explained within the biopsychosocial context of determinants of health (Public Health England, 2018). Health is determined by a complex and interconnected mechanism between individual characteristics, lifestyle, and the physical, social, and economic environmental factors. In this essay, a case scenario of a 45-year-old man from a deprived area will be utilised to discuss the impact of one determinant of health, specifically, physical activity, within the socio political and economic context. Physical activity is an essential determinant of health, and in particular, concerning cardiovascular diseases and disorders. Regular physical activity has been shown to both delay and prevent the onset of high blood pressure (Warburton & Bredin, 2016; Rhodes et al., 2017). It also reduces the blood cholesterol levels and therefore minimises the risk of developing cardiovascular diseases.
Overview and detail of rationale and precise relationship to this case study
Familial Hypercholesterolemia is a genetic disorder that raises LDL cholesterol levels (Ibrahim et al., 2017). Typically, Familial Hypercholesterolemia begins at birth and causes individuals to develop heart attacks at a young age (Ibrahim et al., 2017; Rabes et al., 2018). The disorder is caused by a defect on chromosome 19, which makes it impossible for the body to remove LDL (low-density lipoprotein) from the blood. Subsequently, this results in elevated levels of LDL in the blood (Vallejo-Vaz et al., 2018). Patients with Familial Hypercholesterolemia have an elevated risk of developing other cardiovascular diseases and conditions (Bianconi et al., 2020; Mytilinaiou et al., 2018; Norman et al., 2016). Physical activity has been shown to increase the levels of HDL in the blood, which prevents the build-up of cholesterol (Vallejo-Vaz et al., 2018). Usually, physically active women have higher levels of HDL in the blood when compared to physically inactive women. Subsequently, this means that they are less likely to experience a build-up of cholesterol in the blood. Similarly, in their study, Taherkani & Bahri (2020) found out that in obese men, physical activity increased the levels of HDL in the blood.
Additionally, regular physical activity can also change the nature and form of blood cholesterol. In particular, regular physical activity has been shown to improve significantly the size and number of particles transporting cholesterol throughout the body (Alves et al., 2016) .Individuals who exercise regularly often have large particles that transport cholesterol throughout the body (Alves et al., 2016; Temporelli, 2016). Such large particles are less likely to block the arteries. Subsequently, this reduces the likelihood of developing heart attacks (German et al., 2020). In the case of Man Seung, he recently suffered a heart attack. In this regard, regular physical activity may minimise the risk of him experiencing a heart attack again.
In the case provided, the heart attack Man Seung recently suffered can be attributed to high LDL levels, which are a product of Familial Hypercholesterolemia that he is suffering from. In this regard, he should engage in exercise that can lower the LDL levels and increases the HDL levels. Basic exercises such as jogging and running have been shown to lower the blood cholesterol levels greatly. The effects of running on the blood cholesterol levels are exemplified by the findings of Dikariyanto et al., (2015) and Vallejo-Vaz et al., (2017) who found out that long-distance runners experienced significant improvements in the HDL levels when compared to the short distance runners. The long-distance runners also exhibited better blood pressure levels when compared to the short distance runners (Dikariyanto et al., 2015; Vallejo-Vaz et al., 2017). In light of this, Man Seung should start running and jogging to increase the HDL levels.
At 45 years, it may not be straightforward for Man Seung to either run or jog regularly. Arguably, this is because as people ages, their joints weaken which can be exacerbated by high-intensity training such as running and jogging. Various scholars have continually debated on whether walking can be a substitute for running in enhancing cardiovascular health (Varela-Mato, 2016; Lanier et al., 2016; Lavie et al., 2019). In their study, Williams & Thompson (2013) found out that there were no significant differences in outcomes between running and walking. Their study findings demonstrated that what played a crucial role in health outcomes was the amount of exercises as opposed to the type. Specifically, individuals who used the same level of energy experienced a similar benefit, notwithstanding whether they were running or walking. The main benefit of walking is reduced blood pressure and cholesterol levels (Kucio et al., 2017). However, it should get noted that it takes more time to burn calories when walking when compared to running.
Furthermore, Man Seung should consider cycling for fun. Although cycling uses the same amount of energy as jogging, it is easier and smooth on the joints. Specifically, Man Seung should consider cycling when he experiences pains on the hips and joints when he is running. Cycling has been shown to have more or less the same benefits as jogging. For example, in their study, Grontved et al., 2016) observed that individuals who cycled to work have a lower risk of developing high blood cholesterol levels when compared to those who did not. Similarly, Blond et al. (2016) observed that cycling was associated with a reduced risk for cardiovascular diseases. In particular, Blond et al., (2016) observed that in a group of individuals aged between 50 and 65 years, those who cycled regularly experienced fewer heart attacks than those who did in 20 years.
The forms of physical activity discussed in the preceding section are aerobic exercises, which are often recommended for minimising the risk for cardiovascular diseases. Nonetheless, anaerobic exercises such as resistance training are also useful in minimising the risk for cardiovascular diseases and in particular in individuals with high blood cholesterol levels (Lopez et al., 2018; Gentil et al., 2017). In their study, Da Silva et al., (2011) found that the participants who engaged in resistance training cleared LDL in their blood at a faster rate than those who did not. Therefore, for individuals such as Man Seung whose, high LDL levels are attributable to a genetic disease such as Familial Hypercholesterolemia, resistance training is essential.
Besides, lowering LDL cholesterol blood levels, resistance training has also been shown to enhance cardiovascular fitness. In their study, Ho et al. (2012) found out that combining aerobic exercises and resistance training helped individuals lose weight and fat more than either of them alone. The combination of resistance training and aerobic exercises was also associated with significantly improved cardiovascular fitness (Ho et al., 2012). It should also get noted that individuals of all ages can engage in resistance training. Older individuals who engage in resistance training are more likely to experience a substantial reduction in their blood LDL levels compared to those who do not (Ho et al., 2012).
Summary of Key Evidence
In late 2019, the UK’s chief medical officer released an updated version of the physical activity guidelines. In adults, the newly released physical activity guidelines suggest that physical activity is associated with reduced risk for hypertension, stroke, hypertension, and cancer (Department of Health and Social Care, 2020). In previous national physical activity guidelines, it was suggested that individuals should ensure that they obtain a minimum of 10 minutes of physical exercises to ensure that they reap the benefits (Department of Health and Social Care, 2020). However, according to the newly released guidelines, there is no minimum amount of time for which individuals should engage in physical activity (Department of Health and Social Care, 2020). In this regard, Man Seung should ensure that he conducts regular physical exercises even for short periods. Undoubtedly, this is because the benefits of physical activity are accumulative.
Older adults are also encouraged to avoid sedentary lifestyles. Although Man Seung has worked as a manual labourer for the rest of his life, he is less likely to continue working after the recent heart attack he experienced and diagnosis of Familial Hypercholesterolemia. Therefore, this means that he is at an elevated risk of living a sedentary lifestyle. A sedentary lifestyle will only exacerbate Man Seung’s condition. Subsequently, this means that he should exercise regularly, as recommended in the preceding section. Physical activity combined with proper nutrition can help minimise the severity of Familial Hypercholesterolemia (Warburton & Bredin, 2019; Kwan, 2019).
To sum it up, the essay has provided a robust assessment of the impacts of physical activity on health using the case study provided. The paper has, in particular, demonstrated that Man Seung suffers from a disorder (Familial Hypercholesterolemia), which is associated with increased levels of LDL in the blood. Increased levels of LDL in the blood are further associated with increased risk of cardiovascular disease. Partly, this explains why Man Seung recently experienced a heart attack. Physical activity can help Man Seung overcome the severity of Familial Hypercholesterolemia and also reduce the likelihood of him developing cardiovascular diseases. Conceivably, this is because physical activity not only lowers the LDL blood levels but also improves cardiovascular fitness.
Alves, A. J., Viana, J. L., Cavalcante, S. L., Oliveira, N. L., Duarte, J. A., Mota, J., … & Ribeiro, F. (2016). Physical activity in primary and secondary prevention of cardiovascular disease: Overview updated. World journal of cardiology, 8(10), 575.
Bianconi, V., Banach, M., Pirro, M., & Panel, I. L. E. (2020). Why Patients With Familial Hypercholesterolemia Are At High Cardiovascular Risk? Beyond LDL-C Levels. Trends in Cardiovascular Medicine.
Blond, K., Jensen, M. K., Rasmussen, M. G., Overvad, K., Tjønneland, A., Østergaard, L., & Grøntved, A. (2016). Prospective study of bicycling and risk of coronary heart disease in Danish men and women. Circulation, 134(18), 1409-1411.
Da Silva, J. L., Vinagre, C. G., Morikawa, A. T., Alves, M. J. N., Mesquita, C. H., & Maranhão, R. C. (2011). Resistance training changes LDL metabolism in normolipidemic subjects: a study with a nanoemulsion mimetic of LDL. Atherosclerosis, 219(2), 532-537.
Department of Health and Social Care. (2020, January 09). Physical activity guidelines: UK Chief Medical Officers’ report. Retrieved October 20, 2020, from https://www.gov.uk/government/publications/physical-activity-guidelines-uk-chief-medical-officers-report
Dikariyanto, V., Smith, L., Francis, L., Robertson, M., Kusaslan, E., O’Callaghan-Latham, M., … & Whitcher, B. (2020). Snacking on whole almonds for 6 weeks improves endothelial function and lowers LDL cholesterol but does not affect liver fat and other cardiometabolic risk factors in healthy adults: the ATTIS study, a randomized controlled trial. The American journal of clinical nutrition, 111(6), 1178-1189.
Fragala, M. S., Cadore, E. L., Dorgo, S., Izquierdo, M., Kraemer, W. J., Peterson, M. D., & Ryan, E. D. (2019). Resistance training for older adults: position statement from the national strength and conditioning association. The Journal of Strength & Conditioning Research, 33(8).
Gentil, P., Steele, J., & Fisher, J. (2017). Why intensity is not a bad word–benefits and practical aspects of high effort resistance training to the older adult. Clinical Nutrition, 36(5), 1454-1455.
German, C., Makarem, N., Fanning, J., Redline, S., Elfassy, T., McClain, A., … & Carnethon, M. (2020). Sleep, Sedentary Behavior, Physical Activity, and Cardiovascular Health: MESA. Medicine and science in sports and exercise.
Grøntved, A., Koivula, R. W., Johansson, I., Wennberg, P., Østergaard, L., Hallmans, G., … & Franks, P. W. (2016). Bicycling to work and primordial prevention of cardiovascular risk: a cohort study among Swedish men and women. Journal of the American Heart Association, 5(11), e004413.
Ho, S. S., Dhaliwal, S. S., Hills, A. P., & Pal, S. (2012). The effect of 12 weeks of aerobic, resistance or combination exercise training on cardiovascular risk factors in the overweight and obese in a randomized trial. BMC public health, 12(1), 704
Ibrahim, S., Reeskamp, L. F., Stroes, E. S., & Watts, G. F. (2020). Advances, gaps and opportunities in the detection of familial hypercholesterolemia: overview of current and future screening and detection methods. Current Opinion in Lipidology.
Kucio, C., Narloch, D., Kucio, E., & Kurek, J. (2017). The application of Nordic walking in the treatment hypertension and obesity. Family Medicine & Primary Care Review, (2), 144-148.
Kwan, J. (2019). Importance of Physical Activity for Successful Aging. The Health & Fitness Journal of Canada, 12(3), 183-188.
Lanier, J. B., Bury, D. C., & Richardson, S. W. (2016). Diet and physical activity for cardiovascular disease prevention. American family physician, 93(11), 919-924.
Lavie, C. J., Ozemek, C., Carbone, S., Katzmarzyk, P. T., & Blair, S. N. (2019). Sedentary behavior, exercise, and cardiovascular health. Circulation research, 124(5), 799-815.
Lopez, P., Pinto, R. S., Radaelli, R., Rech, A., Grazioli, R., Izquierdo, M., & Cadore, E. L. (2018). Benefits of resistance training in physically frail elderly: a systematic review. Aging clinical and experimental research, 30(8), 889-899.
Mytilinaiou, M., Kyrou, I., Khan, M., Grammatopoulos, D. K., & Randeva, H. S. (2018). Familial hypercholesterolemia: new horizons for diagnosis and effective management. Frontiers in pharmacology, 9, 707.
Norman, R., Watts, G. F., Weintraub, W., & Gidding, S. S. (2016). Challenges in the health economics of familial hypercholesterolemia. Current Opinion in Lipidology, 27(6), 563-569.
Public health England. (2018). Fiscal and pricing policies to improve public health: a review of evidence. Retrieved from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/ attachment_data/file/743118/Fiscal_and_Pricing_Policies_report_FINAL.pdf
Rabès, J. P., Béliard, S., & Carrié, A. (2018). Familial hypercholesterolemia: experience from France. Current opinion in lipidology, 29(2), 65-71.
Rhodes, R. E., Janssen, I., Bredin, S. S., Warburton, D. E., & Bauman, A. (2017). Physical activity: Health impact, prevalence, correlates and interventions. Psychology & Health, 32(8), 942-975.
Taherkhani, S., & Bahri, F. (2020). Evaluation of the effect of 8 weeks of aerobic exercise on triglyceride, cholesterol, HDL, LDL, and hyperglycemic indicators of overweight men. Journal of Advanced Pharmacy Education & Research| Jan-Mar, 10(S1), 169.
Temporelli, P. L. (2016). Physical activity and cardiovascular health. Giornale italiano di cardiologia (2006), 17(3), 176.
Varela-Mato, V. (2016). Sedentary behaviours, physical activity and cardiovascular health amongst bus and lorry drivers (Doctoral dissertation, Loughborough University).
Vallejo-Vaz, A. J., Robertson, M., Catapano, A. L., Watts, G. F., Kastelein, J. J., Packard, C. J., … & Ray, K. K. (2017). Low-density lipoprotein cholesterol lowering for the primary prevention of cardiovascular disease among men with primary elevations of low-density lipoprotein cholesterol levels of 190 mg/dL or above: analyses from the WOSCOPS (West of Scotland Coronary Prevention Study) 5-year randomized trial and 20-year observational follow-up. Circulation, 136(20), 1878-1891.
Vallejo-Vaz, A. J., De Marco, M., Stevens, C. A., Akram, A., Freiberger, T., Hovingh, G. K., … & Soran, H. (2018). Overview of the current status of familial hypercholesterolaemia care in over 60 countries-The EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC). Atherosclerosis, 277, 234-255.
Warburton, D. E., & Bredin, S. S. (2016). Reflections on physical activity and health: what should we recommend?. Canadian Journal of Cardiology, 32(4), 495-504.
Warburton, D. E., & Bredin, S. S. (2019). Health benefits of physical activity: A strengths-based approach.
Williams, P. T., & Thompson, P. D. (2013). Walking versus running for hypertension, cholesterol, and diabetes mellitus risk reduction. Arteriosclerosis, thrombosis, and vascular biology, 33(5), 1085-1091