[Conducting a multimodal exercise program in primary and secondary prevention of mobility disabilty in older adults at risk: guidelines and practical applications]. / Conduite d'un programme d'exercice multimodal en prévention primaire et secondaire de la perte de mobilité chez le senior à risque : recommandations et applications pratiques.

The implementation of strategies to prevent mobility disability in seniors at-risk with a strong focus on exercise is a public health imperative. These strategies must follow a pragmatic, structured and personalized approach. In order to obtain short, medium and long-term benefits, it is essential to consider the coordination of adapted physical exercise programs and to harmonize good practices. In support of national policies for the prevention of loss of autonomy, it is important to define clear guidelines to conduct effective programs. These programs should have a strong emphasis on evidence-based literature and should be validated by a consensus of multi-professional experts. The aim of this consensus is to outline the steps implementing these programs, to present their constituent elements and their practical application. Conception and elaboration of these programs should include frequency, intensity, duration, type of work, volume and individual progressiveness. Programs should also be focused on a personalised approach to develop participant health education, self-efficacy and empowerment for physical activity to ensure long-term health related behaviours. Moreover, trained professionals must supervise these programs in order to assure participants safety and program effectiveness. These guidelines will support policies for the prevention of loss of autonomy and mobility, throughout their development over the national territory.

Costing the economic burden of prolonged sedentary behaviours in France.

BACKGROUND: There is strong evidence showing that sedentary behaviour time increase the risk to develop several chronic diseases and to premature death. The economic consequences of this risk have never been evaluated in France. The aim of this study was to estimate the economic burden of prolonged sedentary behaviour in France. METHODS: Based on individual sedentary behaviour time, relative risk to develop cardiovascular disease, colon cancer, breast cancer and all-causes of premature mortality were identified. From relative risk and prevalence of sedentary behaviour time, a population attributable fraction approach was used to estimate the yearly number of cases for each disease. Data from the National Health Insurance were used to calculate the annual average costs per case for each disease. Disease-specific and total healthcare costs attributable to prolonged sedentary behaviour time were calculated. Indirect costs from productivity loss due to morbidity and premature mortality were estimated using a friction cost approach. RESULTS: In France, 51 193 premature deaths/year appear related to a prolonged daily sedentary behaviour time. Each year prolonged sedentary behaviour cost 494 million € for the national health insurance. Yearly productivity loss due to premature mortality attributable to prolonged sedentary behaviour cost 507 million € and yearly productivity loss due to morbidity cost between 43 and 147 million €. CONCLUSION: Significant saving and many deaths could be avoided by reducing prolonged sedentary behaviour prevalence in France. To address this issue, strong responses should be implemented to tackle sedentary behaviour, complementary to physical activity promotion.