Physical Activity Non-Communicable Diseases and Immunity Research (PANDIR) Group
The World Health Organisation (WHO) has stated that Chronic diseases, such as heart disease, stroke, cancer, chronic respiratory diseases and diabetes, are by far the leading cause of mortality in the world, representing 63% of all deaths. Out of the 36 million people who died from chronic disease in 2008, 29% were under 60 and half were women. 80% of all deaths are from low or middle income countries. It has been argued that unless addressed, the mortality and disease burden from these health problems will continue to increase. The WHO projects that, globally, chronic disease associated deaths will increase by 17% over the next ten years. The greatest increase will be seen in the African region (27%) and the Eastern Mediterranean region (25%).
Over the past decade it has become evident that physical exercise offers protection against a cluster of chronic diseases to the extent that exercise can be described as medicine for these diseases, and not just protection (Walsh et al., 2011).
It is well-established that physical inactivity increases the risk of type 2 diabetes (Tuomilehto et al., 2001), cardiovascular diseases (Nocon et al., 2008), colon cancer (Wolin et al., 2009), breast cancer (Monninkhof et al., 2007), dementia (Rovio et al., 2005) and depression (Paffenbarger et al., 1994). Physical inactivity leads to the accumulation of visceral fat and consequently the activation of a network of inflammatory pathways. Chronic inflammation promotes the development of insulin resistance, atherosclerosis, neurodegeneration, and tumour growth (Handschin et al., 2008), and subsequently the development of a number of diseases associated with physical inactivity.
Evidence suggests that the prophylactic effect of exercise may, to some extent, be ascribed to the anti-inflammatory effect of regular exercise mediated via a reduction in visceral fat mass and/or by establishment of an anti-inflammatory environment with each bout of exercise (e.g. via increases in circulating anti-inflammatory cytokines including interleukin (IL)-1 receptor antagonist and IL-10) (Walsh et al., 2011; Pedersen, 2009). Several studies show that markers of inflammation are reduced following longer term behavioural changes involving reduced energy intake and increased physical activity (Petersen et al., 2005).
Patients with chronic inflammatory diseases such as type 2 diabetes are often prescribed exercise to improve quality of life; however, the use of exercise as a treatment for these diseases remains controversial. A systemic review has highlighted that acute and chronic exercise may elicit different responses in patients with chronic inflammatory disease when compared with healthy controls (Ploeger et al., 2009). For example, it has been reported that in patients with chronic obstructive pulmonary disease plasma TNF-α levels were abnormally increased compared with healthy controls following moderate-intensity exercise (Rabinovich et al., 2003).
Therefore, more needs to be understood about the nature of exercise that has anti-inflammatory effects in patients with chronic inflammatory diseases without increasing the underlying inflammatory pathology of the disease, an area that will be investigated by the research chair. The Physical Activity, Non-Communicable Diseases and Immunity Research (PANDIR) Group will also have an important role to play in investigating the impact of exercise on HIV-associated lipodystrophy. It has recently been shown that this condition is associated with hyperlipidemia and chronic inflammation, together with lipid-induced insulin resistance (Lindegaard et al., 2008). This finding together with reports that the increased lifespan in HIV infected individuals has resulted in an increased incidence of chronic disease in these individuals, emphasizes the need for a research group investigating the impact of exercise on chronic diseases of lifestyle, particularly in South Africa and Africa.
The underlying question guiding the research strategy of PANDIR will be “Exercise for chronic disease prevention and treatment, why does it work?”
Research projects counducted by PANDIR aim to understand the mechanism(s) of the protective and beneficial effect of exercise in chronic disease. In particular, the anti-inflammatory role of endurance and strength training exercises remains poorly defined and is an area for future investigation. In addition, PANDIR examines the independent contribution of an exercise-induced reduction in visceral fat versus other exercise-induced anti-inflammatory mechanisms, areas which include clarification. Research projects investigate the nature of exercise that is most efficient at alleviating the effects of chronic inflammation in chronic disease, across the lifespan, genders, ethnic groups and vulnerable groups including the disabled, HIV-infected individuals, children and the elderly.
Alignment of PANDIR with the research strategy of the University of KwaZulu-Natal
The PANDIR group is located in the Discipline of Biokinetics, Exercise and Leisure Sciences that falls within the School of Health Sciences. PANDIR is aligned with the vision and mission of the School of Health Sciences which translates the vision and mission of the University of KwaZulu‐Natal in the Health Sciences context. Specifically, the School of Health Sciences acknowledges that it works within a number of national higher education and health‐related frameworks. The specific framework that the chair is aligned with is the National Department of Health Strategic Plan 2010/11 – 2012/13. This implements a 10‐point plan aimed at creating a well‐functioning health system capable of producing improved health outcomes consisting of 20 deliverables in 4 key areas, viz., increasing life expectancy, combating HIV and AIDS, decreasing the burden of diseases from tuberculosis, and, improving health systems effectiveness.
Alignment of PANDIR with relevant national strategies
With the focus on the prevention and treatment of chronic disease through physical exercise, the PANDIR is directly aligned with the Health Research Policy in South Africa. This policy creates a framework and environment to enable health research to contribute effectively to health development with the aim of improving human health, welfare and quality of life of all South Africans. It does this through supporting the advancement of knowledge that underpins health and equitable quality health care through research and nurturing talent and developing capacity to conduct research and utilize its findings.
Alignment with an identified directed or thematic research area
Through the focus on researching the underlying mechanisms for preventing and treating chronic disease through exercise, PANDIR is aligned to is one of the five priorities of government, specifically, Health. In addition, with its focus on treatment and prevention of chronic disease, PANDIR is aligned with the following prioritised outcome: A long and healthy life for all South Africans.
The directed research area that PANDIR is aligned with is Chronic Disease.
Importantly, chronic diseases can generally not be prevented by vaccines or cured by medication. Specifically, cardiovascular disease, diabetes, chronic respiratory disease, certain cancers and neuropsychiatric conditions (including schizophrenia, bipolar disorder and epilepsy) have been acknowledged as major threats to health in South Africa. The call is for research examining the prevention, early detection and effective monitoring and management of chronic diseases. This will play a role in improving the quality of life and reduce the burden of disease and mortality rates in South Africa.
Alignment with international health strategy
PANDIR is directly aligned with the World Health Organisation (WHO) 2008 – 2013 Action Plan for the Global Strategy for the Prevention and Control of Chronic Disease / NonCommunicable Diseases. The six objective of the action plan are:
1) To raise the priority accorded to chronic disease in development work at global and national levels, and to integrate prevention and control of such diseases into policies across all government departments.
2) To promote research for the prevention and control of chronic diseases.
3) To establish and strengthen national policies and plans for the prevention and control of chronic diseases.
4) To promote interventions to reduce the main shared modifiable risk factors for chronic
diseases : tobacco use, unhealthy diets, physical inactivity and harmful use of alcohol
5) To promote partnerships for the prevention and control of chronic diseases.
6) To monitor chronic diseases and their determinants and evaluate progress at the national, regional and global levels.
Importantly, the WHO has highlighted that research into the prevention and control of chronic diseases is a priority and that interventions should be promoted to reduce physical inactivity levels which is acknowledged as a modifiable risk factor.