title: The modelled impact of increases in physical activity: the effect of both increased survival and reduced incidence of disease.
abstract: Physical activity can affect 'need' for healthcare both by reducing the incidence rate of some diseases and by increasing longevity (increasing the time lived at older ages when disease incidence is higher). However, it is common to consider only the first effect, which may overestimate any reduction in need for healthcare. We developed a hybrid micro-simulation lifetable model, which made allowance for both changes in longevity and risk of disease incidence, to estimate the effects of increases in physical activity (all adults meeting guidelines) on measures of healthcare need for diseases for which physical activity is protective. These were compared with estimates made using comparative risk assessment (CRA) methods, which assumed that longevity was fixed. Using the lifetable model, life expectancy increased by 95 days (95% uncertainty intervals: 68-126 days). Estimates of the healthcare need tended to decrease, but the magnitude of the decreases were noticeably smaller than those estimated using CRA methods (e.g. dementia: change in person-years, -0.6%, 95% uncertainty interval -3.7% to +1.6%; change in incident cases, -0.4%, -3.6% to +1.9%; change in person-years (CRA methods), -4.0%, -7.4% to -1.6%). The pattern of results persisted under different scenarios and sensitivity analyses. For most diseases for which physical activity is protective, increases in physical activity are associated with decreases in indices of healthcare need. However, disease onset may be delayed or time lived with disease may increase, such that the decreases in need may be relatively small and less than is sometimes expected.
authors.affiliation: MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK. otm21@medschl.cam.ac.uk.
authors.forename: Oliver T
authors.initials: OT
authors.lastname: Mytton
authors.affiliation: MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.|Systems Research Institute, Polish Academy of Sciences, Newelska 6, 01-447, Warsaw, Poland.
authors.forename: Marko
authors.initials: M
authors.lastname: Tainio
authors.affiliation: MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
authors.forename: David
authors.initials: D
authors.lastname: Ogilvie
authors.affiliation: MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
authors.forename: Jenna
authors.initials: J
authors.lastname: Panter
authors.affiliation: Centre for Health Policy, School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, Carlton, VIC, 3053, Australia.
authors.forename: Linda
authors.initials: L
authors.lastname: Cobiac
authors.affiliation: MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
authors.forename: James
authors.initials: J
authors.lastname: Woodcock
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D004739:England / Q000453:epidemiology; D015444:Exercise; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009369:Neoplasms / Q000453:epidemiology*; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*; D016019:Survival Analysis
keywords: Disease burden; Lifetable; Modelling; Physical activity; Survival