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Activité physique : impact sur la santé, prévalence, corrélation et interventions



Activité physique : impact sur la santé, prévalence, corrélation et interventions

Introduction


Cet article est une revue de haut niveau concernant l’état actuel de la recherche internationale sur l’activité physique (AP). Il est divisé en 5 sections, correspondant aux points majeurs de la recherche en la matière :
  • La définition de l’activité physique
  • L’impact sur la santé
  • La prévalence et la surveillance
  • Les corrélations et les déterminants
  • Les interventions permettant de modifier l’AP.
 

Définition


Dans son sens le plus simple, l’activité physique se réfère à n’importe quel mouvement corporel qui résulte en une augmentation de la dépense énergétique. L’AP est souvent caractérisée par l’acronyme FITT : F = fréquence, I = intensité, T = temps et T = type (aérobie, anaérobie).
 
Les recommandations de l’OMS en temps d’activité physique sont les suivantes :
 
  • Les enfants de 0 à 4 ans : au minimum 180 minutes d’AP de n’importe quelle intensité, de façon quotidienne, tout au long de la semaine.
  • Les enfants et adolescents de 5 à 17 ans : au minimum 60 min d’activité modérée à plus intense sur une durée quotidienne, tout au long de la semaine.
  • Les adultes de 18 à 64 ans : au minimum 150 minutes d’activité aérobic modérée par semaine, ou au minimum 75 minutes d’activité plus intense par semaine.
  • Les adultes de 65 ans et plus : au minimum 150 minutes d’activité aérobic modérée par semaine, ou au minimum 75 minutes d’activité plus intense par semaine.
 
L’OMS précise que les minutes supplémentaires apportent un réel plus pour la santé.
 
 

Impact sur la santé

  • Mortalité prématurée : une étude épidémiologique récente démontre une relation quantité/conséquence claire entre l’AP et le risque de mortalité toute cause. Les groupes de personnes ayant le moins d’activité sont les plus à risque. Mais les plus grandes réductions de risque ont été constatées chez les personnes ayant le moins d’activité physique lorsqu’elles passaient à un groupe d’activité juste supérieur. De plus, les risques de mortalité ont été diminués avec simplement de petites différences dans le comportement par rapport à l’AP.
 
  • Prévention primaire et secondaire des maladies chroniques : une AP régulière a été associée à la prévention primaire de plus de 25 pathologies chroniques. Le tableau 2 montre les réductions de risques entre les personnes actives et inactives. Il est important de souligner qu’une AP régulière améliore aussi la condition de pathologie qui ne découle pas d’un manque d’AP.
 
  • Développement des aptitudes musculosquelettique (MS) : il y a aujourd’hui des preuves claires que les aptitudes MS sont associées à des indicateurs variés de statut de la santé (particulièrement des statuts fonctionnels)

Activité physique : impact sur la santé, prévalence, corrélation et interventions

Prévalence de l’AP


Basés sur des mesures auto rapportées, les résultats de l’observatoire global suggère qu’en 2010, 23% des adultes au-delà de 18 ans étaient insuffisamment actifs, du fait qu’ils n’accumulaient pas assez d’AP pour rejoindre les critères de recommandations. Plus de femme (27%) que d’homme (20%) sont insuffisamment inactifs, tout comme le sont les personnes âgées (55%) par rapport au plus jeune (19%). Parmi les 11-17 ans, 81% n’accumulent pas au moins 60 minutes journalières d’activités modérées à plus vigoureuses.
 
Globalement, que les mesures soient auto rapportées ou objectives (utilisation de podomètre, d’accéléromètre), une grande partie de la population ne fait pas suffisamment d’AP, quelque soit l’âge ou le pays.
 
Corrélations et déterminants
Les chercheurs ont également investigué les liens qui peuvent amener à être plus ou moins actifs.
 
Chez les enfants et adolescents on peut notamment citer entre autres :
  • L’efficacité dans une activité
  • Les antécédents d’une AP
  • De hauts niveaux perçus de contrôle comportemental
  • Des supports sociaux incitant à être actifs.
 
Pour les adultes :
  • Une bonne santée
  • L’efficacité dans une AP
  • Les effets espérés d’être actif
  • Les antécédents d’AP étant adulte
  • Etre un homme, jeune et avec un niveau d’éducation supérieur.
 
Il apparaît que les enfants de type caucasien en Amérique du Nord et en Europe étaient souvent plus actifs que les minorités ou les enfants migrants. D’un point de vue environnemental, l’accessibilité aux infrastructures (trafic, utilisation de l’espace, répartition des infrastructures, transport public) apparait comme un facteur déterminant.
 

Intervention pour changer l’activité physique


Étant donné l’indiscutable preuve des bénéfices de l’AP sur la santé, l’accablant constat d’une faible prévalence dans la population, et l’évaluation des corrélations sur le comportement actif ou non d’un individu, il y a un besoin d’implanter des interventions efficaces.
 
Dans cette revue de haut niveau, 27 méta analyses et 39 revues narratives ont été identifiées sur les interventions chez les adultes, et 3 méta analyses et 17 revues narratives sur les interventions chez les plus jeunes.
Certaines études se sont concentrées sur des stratégies d’intervention comme :
 
  • Des théories spécifiques appliquées à l’intervention
  • Des techniques de changement de comportement, comme l’établissement d’objectifs et la mise en œuvre des intentions
  • Le changement environnemental
  • L’incitation par la récompense
  • Le soutien par les pairs
 
Les liens de diffusion utilisés sont le téléphone, internet, les médias de masse, des affiches, sur des lieux comme le lieu de travail.
 
Malgré la nécessité de proposer des interventions efficaces, il apparait que l’efficacité des interventions est le plus souvent de petite amplitude. La plupart des revues narratives rapporte une efficacité peu concluante (62% chez les adultes, 70% pour les jeunes). Certaines revues estiment que l’ethnie, le statut socio-économique et le profil d’activité physique de base nécessitent plus de recherches, mais que les résultats suggèrent que l’âge ou le sexe ne sont pas liés à l’efficacité d’une intervention.
 

Conclusion


Cette revue générale sur l’activité physique démontre bien son intérêt pour la santé, autant dans un but curatif que préventif. Malgré son importance, l’AP n’est pas généralisée parmi les populations du monde entier, avec des disparités découlant autant de l’aspect ethnique, socio-économique ou le niveau d’instruction. De plus, les interventions mis en place pour inciter à plus d’activités physiques ne semblent pas montrer autant d’efficacité qu’elles ne le devraient.
Il est donc important, dans notre rôle de professionnel du mouvement, d’accompagner nos patients dans une démarche de sport/santé, à l’heure où le sport sur ordonnance peine à émerger.
 

Article original


Ryan E. Rhodes, Ian Janssen, Shannon S.D. Bredin, Darren E.R. Warburton & Adrian Bauman (2017) Physical activity: Health impact, prevalence, correlates and interventions, Psychology & Health, 32:8, 942-975, DOI: 10.1080/08870446.2017.1325486

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