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Consensus Development Conference Statement December 18-20, 1995
This statement is more than five years old and is provided solely for historical purposes. Due to the cumulative nature of medical research, new knowledge has inevitably accumulated in this subject area in the time since the statement was initially prepared. Thus some of the material is likely to be out of date, and at worst simply wrong. For reliable, current information on this and other health topics, we recommend consulting the National Institutes of Health's MedlinePlus http://www.nlm.nih.gov/medlineplus/. This statement was originally published as: Physical Activity and Cardiovascular Health. NIH Consens Statement 1995 December 18-20;13(3):1-33. For making bibliographic reference to consensus statement no. 101 in the electronic form displayed here, it is recommended that the following format be used: Physical Activity and Cardiovascular Health. NIH Consens Statement Online 1995 December 18-20 [cited year month day]; 13(3):1-33.AbstractObjective.To provide physicians and the general public with a responsible assessment of the relationship between physical activity and cardiovascular health. Participants. A non-Federal, nonadvocate, 13-member panel representing the fields of cardiology, psychology, exercise physiology, nutrition, pediatrics, public health, and epidemiology. In addition, 27 experts in cardiology, psychology, epidemiology, exercise physiology, geriatrics, nutrition, pediatrics, public health, and sports medicine presented data to the panel and a conference audience of 600. Evidence. The literature was searched through Medline and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. Consensus Process.The panel, answering predefined questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. Conclusions. All Americans should engage in regular physical activity at a level appropriate to their capacity, needs, and interest. Children and adults alike should set a goal of accumulating at least 30 minutes of moderate-intensity physical activity on most, and preferably, all days of the week. Most Americans have little or no physical activity in their daily lives, and accumulating evidence indicates that physical inactivity is a major risk factor for cardiovascular disease. However, moderate levels of physical activity confer significant health benefits. Even those who currently meet these daily standards may derive additional health and fitness benefits by becoming more physically active or including more vigorous activity. For those with known cardiovascular disease, cardiac rehabilitation programs that combine physical activity with reduction in other risk factors should be more widely used. IntroductionOver the past 25 years, the United States has experienced a steady decline in the age-adjusted death toll from cardiovascular disease (CVD), primarily in mortality caused by coronary heart disease and stroke. Despite this decline, coronary heart disease remains the leading cause of death and stroke the third leading cause of death. Lifestyle improvements by the American public and better control of the risk factors for heart disease and stroke have been major factors in this decline. Coronary heart disease and stroke have many causes. Modifiable risk factors include smoking, high blood pressure, blood lipid levels, obesity, diabetes, and physical inactivity. In contrast to the positive national trends observed with cigarette smoking, high blood pressure, and high blood cholesterol, obesity and physical inactivity in the United States have not improved. Indeed automation and other technologies have contributed greatly to lessening physical activity at work and home. The purpose of this conference was to examine the accumulating evidence on the role of physical activity in the prevention and treatment of CVD and its risk factors. Physical activity in this statement is defined as "bodily movement produced by skeletal muscles that requires energy expenditure" and produces healthy benefits. Exercise, a type of physical activity, is defined as "a planned, structured, and repetitive bodily movement done to improve or maintain one or more components of physical fitness." Physical inactivity denotes a level of activity less than that needed to maintain good health. Physical inactivity characterizes most Americans. Exertion has been systematically engineered out of most occupations and lifestyles. In 1991, 54 percent of adults reported little or no regular leisure physical activity. Data from the 1990 Youth Risk Behavior Survey show that most teenagers in grades 9-12 are not performing regular vigorous activity. About 50 percent of high school students reported they are not enrolled in physical education classes. Physical activity protects against the development of CVD and also favorably modifies other CVD risk factors, including high blood pressure, blood lipid levels, insulin resistance, and obesity. The type, frequency, and intensity of physical activity that are needed to accomplish these goals remain poorly defined and controversial. Physical activity is also important in the treatment and management of patients with CVD or increased risk, including those who have hypertension, stable angina, a prior myocardial infraction, peripheral vascular disease, or heart failure. Physical activity is an important component of cardiac rehabilitation, and people with CVD may benefit from participation. In addition to potential advantages, questions remain regarding benefits, risks, and costs associated with becoming physically active. Many factors influence adopting and maintaining a physically active lifestyle, such as socioeconomic status, cultural influences, age, and health status. Understanding is needed on how such variables influence the adoption of this behavior at the individual level. Intervention strategies for encouraging individuals from different backgrounds to adopt and adhere to a physically active lifestyle need to be developed and tested. Different environments such as schools, worksites, health care settings, and the home can play a role in promoting physical activity. These community-level factors also need to be better understood. To address these and related issues, the National Heart, Lung, and Blood Institute and the NIH Office of Medical Applications of Research convened a Consensus Development Conference on Physical Activity and Cardiovascular Health. The conference was cosponsored by the National Institute of Child Health and Human Development, the National Institute on Aging, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute of Nursing Research, and the Office of Research on Women's Health and the Office of Disease Prevention of the NIH; the Centers for Disease Control and Prevention; and the President's Council on Physical Fitness and Sports. The conference brought together specialists in medicine, exercise physiology, health behavior, epidemiology, nutrition, physical therapy, and nursing as well as representatives from the public. After 1-1/2 days of presentations and audience discussion, an independent, non-Federal consensus panel weighed the scientific evidence and developed a draft statement that addressed the following five questions.
Physical inactivity among the U.S. population is now widespread. National surveillance programs have documented that about one in four adults (more women than men) currently have sedentary lifestyles with no leisure time physical activity. An additional one-third of adults are insufficiently active to achieve health benefits. The prevalence of inactivity varies by gender, age, ethnicity, health status, and geographic region but is common to all demographic groups. Change in physical exertion associated with occupation has declined markedly in this century. Girls become less active than do boys as they grow older. Children become far less active as they move through adolescence. Obesity is increasing among children. It is related to an energy imbalance (i.e., calories consumed in excess of calorie expenditure [physical activity].) Data indicate that obese children and adolescents have a high risk of becoming obese adults, and obesity in adulthood is related to coronary artery disease, hypertension, and diabetes. Thus, the prevention of childhood obesity has the potential of preventing CVD in adults. At age 12, 70 percent of children report participation in vigorous physical activity; by age 21 this activity falls to 42 percent for men and 30 percent for women. Furthermore, as adults age, their physical activity levels continue to decline. Although knowledge about physical inactivity as a risk factor for CVD has come mainly from investigations of middle-aged, white men, more limited evidence from studies in women minority groups and the elderly suggests that the findings are similar in these groups. On the basis of current knowledge, we must note that physical inactivity occurs disproportionately among Americans who are not well educated and who are socially or economically disadvantaged. Physical activity is directly related to physical fitness. Although the means of measuring physical activity have varied between studies (i.e., there is no standardization of measures), evidence indicates that physical inactivity and lack of physical fitness are directly associated with increased mortality from CVD. The increase in mortality is not entirely explained by the association with elevated blood pressure, smoking, and blood lipid levels. There is an inverse relationship between measures of physical activity and indices of obesity in most U.S. population studies. Only a few studies have examined the relationship between physical activity and body fat distribution, and these suggest an inverse relationship between levels of physical activity and visceral fat. There is evidence that increased physical activity facilitates weight loss and that the addition of physical activity to dietary energy restriction can increase and help to maintain loss of body weight and body fat mass. Middle-aged and older men and women who engage in regular physical activity have significantly higher high-density lipoprotein (HDL) cholesterol levels than do those who are sedentary. When exercise training has extended to at least 12 weeks, beneficial HDL cholesterol level changes have been reported. Most studies of endurance exercise training of individuals with normal blood pressure and those with hypertension have shown decreases in systolic and diastolic blood pressure. Insulin sensitivity is also improved with endurance exercise. A number of factors that affect thrombotic function -- including hematocrit, fibrinogen, platelet function, and fibrinolysis -- are related to the risk of CVD. Regular endurance exercise lowers the risk related to these factors. The burden of CVD rests most heavily on the least active. In addition to its powerful impact on the cardiovascular system, physical inactivity is also associated with other adverse health effects, including osteoporosis, diabetes, and some cancers. 2. What Type, What Intensity, and What Quantity of Physical Activity Are Important To Prevent Cardiovascular Disease?Activity that reduces CVD risk factors and confers many other health benefits does not require a structured or vigorous exercise program. The majority of benefits of physical activity can be gained by performing moderate-intensity activities. The amount or type of physical activity needed for health benefits or optimal health is a concern due to limited time and competing activities for most Americans. The amount and types of physical activity that are needed to prevent disease and promote health must, therefore, be clearly communicated, and effective strategies must be developed to promote physical activity to the public. The quantitative relationship between level of activity or fitness and magnitude of cardiovascular benefit may extend across the full range of activity. A moderate level of physical activity confers health benefits. However, physical activity must be performed regularly to maintain these effects. Moderate-intensity activity performed by previously sedentary individuals results in significant improvement in many health-related outcomes. These moderate-intensity activities are more likely to be continued than are high-intensity activities. We recommend that all people in the United States increase their regular physical activity to a level appropriate to their capacities, needs, and interest. We recommend that all children and adults should set a long-term goal to accumulate at least 30 minutes or more of moderate-intensity physical activity on most, or preferably all, days of the week. Intermittent or shorter bouts of activity (at least 10 minutes), including occupational, nonoccupational, or tasks of daily living, also have similar cardiovascular and health benefits if performed at a level of moderate intensity (such as brisk walking, cycling, swimming, home repair, and yardwork) with an accumulated duration of at least 30 minutes per day. People who currently meet the recommended minimal standards may derive additional health and fitness benefits from becoming more physically active or including more vigorous activity. Some evidence suggests lowered mortality with more vigorous activity, but further research is needed to more specifically define safe and effective levels. The most active individuals have lower cardiovascular morbidity and mortality rates than do those who are least active; however, much of the benefit appears to be accounted for by comparing the least active individuals to those who are moderately active. Further increases in the intensity or amount of activity produce further benefits in some, but not all, parameters of risk. High-intensity activity is also associated with an increased risk of injury, discontinuation of activity, or acute cardiac events during the activity. Current low rates of regular activity in Americans may be partially due to the misperception of many that vigorous, continuous exercise is necessary to reap health benefits. Many people, for example, fail to appreciate walking as "exercise" or to recognize the substantial benefits of short bouts (at least 10 minutes) of moderate-level activity. The frequency, intensity, and duration of activity are interrelated. The number of episodes of activity recommended for health depends on the intensity and/or duration of the activity: higher intensity or longer duration activity could be performed approximately three times weekly and achieve cardiovascular benefits, but low-intensity or shorter duration activities should be performed more often to achieve cardiovascular benefits. The appropriate type of activity is best determined by the individual's preferences and what will be sustained. Exercise, or a structured program of activity, is a subset of activity that may encourage interest and allow for more vigorous activity. People who perform more formal exercise (i.e., structured or planned exercise programs) can accumulate this daily total through a variety of recreational or sports activities. People who are currently sedentary or minimally active should gradually build up to the recommended goal of 30 minutes of moderate activity daily by adding a few minutes each day until reaching their personal goal to reduce the risk associated with suddenly increasing the amount or intensity of exercise. (The defined levels of effort depend on individual characteristics such as baseline fitness and health status.) Developing muscular strength and joint flexibility is also important for an overall activity program to improve one's ability to perform tasks and to reduce the potential for injury. Upper extremity and resistance (or strength) training can improve muscular function, and evidence suggests that there may be cardiovascular benefits, especially in older patients or those with underlying CVD, but further research and guidelines are needed. Older people or those who have been deconditioned from recent inactivity or illness may particularly benefit from resistance training due to improved ability in accomplishing tasks of daily living. Resistance training may contribute to better balance, coordination, and agility that may help prevent falls in the elderly. Physical activity carries risks as well as benefits. The most common adverse effects of activity relate to musculoskeletal injury and are usually mild and self-limited. The risk of injury increases with increased intensity, frequency, and duration of activity and also depends on the type of activity. Exercise-related injuries can be reduced by moderating these parameters. A more serious but rare complication of activity is myocardial infraction or sudden cardiac death. Although persons who engage in vigorous physical activity have a slight increase in risk of sudden cardiac death during activity, the health benefits outweigh this risk because of the large overall risk reduction. In children and young adults, exertion-related deaths are uncommon and are generally related to congenital heart defects (e.g., hypertrophic cardiomyopathy, Marfan's syndrome, severe aortic valve stenosis, prolonged QT syndromes, cardiac conduction abnormalities) or to acquired myocarditis. It is recommended that patients with those conditions remain active but not participate in vigorous or competitive athletics. Because the risks of physical activity are very low compared with the health benefits, most adults do not need medical consultation or pretesting before starting a moderate-intensity physical activity program. However, those with known CVD and men over age 40 and women over age 50 with multiple cardiovascular risk factors who contemplate a program of vigorous activity should have a medical evaluation prior to initiating such a program. 3. What Are the Benefits and Risks of Different Types of Physical Activity for People With Cardiovascular Disease?More than 10 million Americans are afflicted with clinically significant CVD, including myocardial infraction, angina pectoris, peripheral vascular disease, and congestive heart failure. In addition, more than 300,000 patients per year are currently subjected to coronary artery bypass surgery and a similar number to percutaneous transluminal coronary angioplasty. Increased physical activity appears to benefit each of these groups. Benefits include reduction in cardiovascular mortality, reduction of symptoms, improvement in exercise tolerance and functional capacity, and improvement in psychological well-being and quality of life. Several studies have shown that exercise training programs significantly reduce overall mortality, as well as death caused by myocardial infraction. The reported reductions in mortality have been highest -- approximately 25 percent -- in cardiac rehabilitation programs that have included control of other cardiovascular risk factors. Rehabilitation programs using both moderate and vigorous physical activity have been associated with reductions in fatal cardiac events, although the minimal or optimal level and duration of exercise required to achieve beneficial effects remain uncertain. Data are inadequate to determine whether stroke incidence is affected by physical activity or exercise training. The risk of death during medically supervised cardiac exercise training programs is very low. However, those who exercise infrequently and have poor functional capacity at baseline may be at somewhat higher risk during exercise training. All patients with CVD should have a medical evaluation prior to participation in a vigorous exercise program. Appropriately prescribed and conducted exercise training programs improve exercise tolerance and physical fitness in patients with coronary heart disease. Moderate as well as vigorous exercise training regimens are of value. Patients with low basal levels of exercise capacity experience the most functional benefits, even at relatively modest levels of physical activity. Patients with angina pectoris typically experience improvement in angina in association with a reduction in effort-induced myocardial ischemia, presumably as a result of decreased myocardial oxygen demand and increased work capacity. Patients with congestive heart failure also appear to show improvement in symptoms, exercise capacity, and functional well-being in response to exercise training, even though left ventricular systolic function appears to be unaffected. The exercise program should be tailored to the needs of these patients and supervised closely in view of the marked predisposition of these patients to ischemic events and arrhythmias. Cardiac rehabilitation exercise training often improves skeletal muscle strength and oxidative capacity and, when combined with appropriate nutritional changes, may result in weight loss. In addition, such training generally results in improvement in measures of psychological status, social adjustment, and functional capacity. However, cardiac rehabilitation exercise training has less influence on rates of return to work than many nonexercise variables, including employer attitudes, prior employment status, and economic incentives. Multifactorial intervention programs -- including nutritional changes and medication plus exercise -- are needed to improve health status and reduce cardiovascular disease risk. Cardiac rehabilitation programs have traditionally been institutional-based and group-centered (e.g., hospitals, clinics, community centers). Referral and enrollment rates have been relatively low, generally ranging from 10 to 25 percent of patients with CHD. Referral rates are lower for women than for men and lower for non-whites than for whites. Home-based programs have the potential to provide rehabilitative services to a wider population. Home-based programs incorporating limited hospital visits with regular mail or telephone followup by a nurse case manager have demonstrated significant increases in functional capacity, smoking cessation, and improvement in blood lipid levels. A range of options exists in cardiac rehabilitation including site, number of visits, monitoring, and other services. There are clear medical and economic reasons for carrying out cardiac rehabilitation programs. Optimal outcomes are achieved when exercise training is combined with educational messages and feedback about changing lifestyle. Patients who participate in cardiac rehabilitation programs show a lower incidence of rehospitalization and lower charges per hospitalization. Cardiac rehabilitation is a cost-efficient therapeutic modality that should be used more frequently. 4. What Are the Successful Approaches To Adopting and Maintaining a Physically Active Lifestyle?The cardiovascular benefits from and physiological reactions to physical activity appear to be similar among diverse population subgroups defined by age, gender, income, region of residence, ethnic background, and health status. However, the behavioral and attitudinal factors that influence the motivation for and ability to sustain physical activity are strongly determined by social experiences, cultural background, and physical disability and health status. For example, perceptions of appropriate physical activity differ by gender, age, weight, marital status, family roles and responsibilities, disability, and social class. Thus, the following general guidelines will need to be further refined when one is planning with or prescribing for specific individuals and population groups, but generally physical activity is more likely to be initiated and maintained if the individual:
Other people in the individual's social environment can influence the adoption and maintenance of physical activity. Health care providers have a key role in promoting smoking cessation and other risk-reduction behaviors. Preliminary evidence suggests that this also applies to physical activity. It is highly probable that people will be more likely to increase their physical activity if their health care provider counsels them to do so. Providers can do this effectively by learning to recognize stages of behavior change, to communicate the need for increased activity, to assist the patient in initiating activity, and by following up appropriately. Family and friends can also be important sources of support for behavior change. For example, spouses or friends can serve as "buddies," joining in the physical activity; or a spouse could offer to take on a household task, giving his or her mate time to engage in physical activity. Parents can support their children's activity by providing transportation, praise, and encouragement, and by participating in activities with their children. Worksites have the potential to encourage increased physical activity by offering opportunities, reminders, and rewards for doing so. For example, an appropriate indoor area can be set aside to enable walking during lunch hours. Signs placed near elevators can encourage the use of the stairs instead. Discounts on parking fees can be offered to employees who elect to park in remote lots and walk. Schools are a major community resource for increasing physical activity, particularly given the urgent need to develop strategies that affect children and adolescents. As noted previously, there is now clear evidence that U.S. children and adolescents have become more obese. There is also evidence that obese children and adolescents exercise less than their leaner peers. All schools should provide opportunities for physical activities that:
Successful approaches may involve mass education strategies or changes
in institutional policies or community variables. In some environments
(e.g., schools, worksites, community centers), policy-level interventions
may be necessary to enable people to achieve and maintain an adequate
level of activity. Policy changes that increase opportunities for physical
activity can facilitate activity maintenance for motivated individuals and
increase readiness to change among the less motivated. As in other areas
of health promotion, mass communication strategies should be used to
promote physical activity. These strategies should include a variety of
mainstream channels and techniques to reach diverse audiences that acquire
information through different media (e.g., TV, newspaper, radio,
Internet). 5. What Are the Important Considerations for Future Research?While much has been learned about the role of physical activity in cardiovascular health, there are many unanswered questions.
Conclusions Accumulating scientific evidence indicates that physical inactivity is a major risk factor for CVD. Moderate levels of regular physical activity confer significant health benefits. Unfortunately, most Americans have little or no physical activity in their daily lives. All Americans should engage in regular physical activity at a level appropriate to their capacities, needs, and interests. All children and adults should set and reach a goal of accumulating at least 30 minutes of moderate-intensity physical activity on most, and preferably all, days of the week. Those who currently meet these standards may derive additional health and fitness benefits by becoming more physically active or including more vigorous activity. Cardiac rehabilitation programs that combine physical activity with reduction in other risk factors should be more widely applied to those with known CVD. Well-designed rehabilitation programs have benefits that are lost because of these programs' limited use. Individuals with CVD and men over 40 or women over 50 years of age with multiple cardiovascular risk factors should have a medical evaluation prior to embarking on a vigorous exercise program. Recognizing the importance of individual and societal factors in initiating and sustaining regular physical activity, the panel recommends the following:
The implementation of the recommendations in this statement has
considerable potential to improve the health and well-being of American
citizens. Consensus Development Panel
Panel and Conference Chairperson Professor and Head Division of Epidemiology School of Public Health University of Minnesota Minneapolis, Minnesota
Professor and Program Director Center for Pediatric Psychology Research University of Florida Gainesville, Florida
Professor and Dean Emeritus School of Public Health University of California, Los Angeles Los Angeles, California
Dean and Professor of Medicine Boston University School of Medicine Boston, Massachusetts
Professor of Biostatistics Director, Collaborative Studies Coordinating Center Department of Biostatistics School of Public Health University of North Carolina at Chapel Hill Chapel Hill, North Carolina
Professor of Molecular Physiology and Biological Physics University of Virginia Medical School Charlottesville, Virginia
Professor and Associate Director for Epidemiology Center for Biostatistics and Epidemiology Pennsylvania State University College of Medicine Hershey, Pennsylvania
Professor of Pediatrics, Preventive Medicine, and Occupational Health Director, Division of Pediatric Cardiology University of Iowa Hospitals and Clinics Iowa City, Iowa
Senior Vice President Nations Bank Charlotte, North Carolina
Associate Professor Division of Preventive Cardiology Departments of Family Medicine and Medicine University of Wisconsin-Madison Madison, Wisconsin
Director, Vascular Biology and Hypertension Program Division of Cardiovascular Disease Department of Medicine University of Alabama at Birmingham Birmingham, Alabama
Professor and Chair Department of Epidemiology University of Miami School of Medicine Miami, Florida
Vice President Rocky Mountain Pediatric Cardiology Denver, Colorado Speakers
"Effects of Physical Activity on Cardiovascular Disease Mortality Independent of Risk Factors" Director of Research Director, Epidemiology and Clinical Applications Cooper Institute for Aerobics Research Dallas, Texas
"Behavioral and Psychosocial Issues of Cardiac Rehabilitation" Professor Division of Medical Psychology Department of Psychiatry Duke University Medical Center Durham, North Carolina
"Overview of the Biological and Physiological Mechanisms by Which Different Forms of Physical Activity Prevent CVD" Professor Physical Activity Sciences Laboratory Laval University Sainte Foy, Quebec, Canada
"Physical Activity Interventions in Older Adults" Professor of Health Services and Medicine Department of Health Services School of Public Health and Community Medicine University of Washington Seattle, Washington
"Prevalence of Physical Inactivity in the United States" Physical Activity Epidemiologist Cardiovascular Health Studies Branch Division of Chronic Disease Control and Community Intervention National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention Atlanta, Georgia
"Physical Activity in Women" Chief, Psychology Service Jackson Veterans Affairs Medical Center Professor, Psychiatry and Human Behavior University of Mississippi School of Medicine Jackson, Mississippi
"Physical Activity, Coagulability, and Fibrinolysis" Professor of Medicine Hematology-Oncology Section Department of Medicine University of Oklahoma Health Sciences Center Oklahoma City, Oklahoma
"Update on Secondary Prevention of Cardiovascular Disease and Exercise-Based Cardiac Rehabilitation" Director, Cardiac Rehabilitation and Exercise Laboratories William Beaumont Hospital Beaumont Rehabilitation and Health Center Professor of Physiology Wayne State University School of Medicine Birmingham, Michigan
"Physical Activity, Physical Fitness, and Blood Pressure" Professor of Medicine Division of Preventive Cardiology Department of Medicine University of Pittsburgh Medical Center Pittsburgh, Pennsylvania
"Physical Activity, Lifestyle, and Health in America" Professor Division of Cardiology Department of Medicine Stanford University School of Medicine Palo Alto, California
"Physical Activity, Body Weight, and Body Fat Distribution" Associate Professor of Pediatrics Associate Director Center for Human Nutrition School of Medicine University of Colorado Health Sciences Center Denver, Colorado
"Does the Mode of Delivery of Cardiac Rehabilitation Influence Outcome?" Associate Director Stanford Cardiac Rehabilitation Program Stanford University School of Medicine Palo Alto, California
"What Is the Magnitude of Risk for Cardiovascular Disease Associated With Sedentary Living Habits?" Director of Research, Sports Medicine Baylor Sports Medicine Institute Baylor College of Medicine Houston, Texas
"Effectiveness of Physical Activity Interventions in Minority Populations" Assistant Professor Department of Epidemiology Graduate School of Public Health University of Pittsburgh Pittsburgh, Pennsylvania
"Is Vigorous Physical Activity Necessary To Reduce the Risk of Cardiovascular Disease?" Assistant Professor of Medicine Harvard Medical School Assistant Professor of Epidemiology Harvard School of Public Health Boston, Massachusetts
"Contributions of Regular Moderate-Intensity Physical Activity to Reduced Risk of Coronary Heart Disease" Henry L. Taylor Professorship in Exercise Science and Health Enhancement Division of Kinesiology School of Kinesiology and Leisure Studies College of Education University of Minnesota Minneapolis, Minnesota
"Determinants of Physical Activity Behavior and Implications for Interventions" Associate Professor of Psychiatry and Human Behavior Division of Behavioral and Preventive Medicine Department of Psychiatry Miriam Hospital and Brown University School of Medicine Providence, Rhode Island
"Health-Related Quality-of-Life and Economic Evaluation of Cardiac Rehabilitation" Professor Department of Health Sciences School of Allied Health Professions University of Wisconsin Milwaukee, Wisconsin
"Physical Activity in Children and Adolescents" Chairman Department of Exercise Science School of Public Health University of South Carolina Columbia, South Carolina
"The Impact of Health Care Providers on Physical Activity" Director, Project PACE Associate Clinical Professor of Family and Preventive Medicine University of California, San Diego Adjunct Professor of Public Health San Diego State University San Diego, California
"Population Attributable Risk of Physical Inactivity" Associate Director for Science Division of Violence Prevention National Center for Injury Prevention and Control Centers for Disease Control and Prevention Atlanta, Georgia
"Community-Based Interventions for Increasing Physical Activity" Assistant Professor Johns Hopkins Center for Health Promotion Johns Hopkins University School of Medicine Baltimore, Maryland
"Physical Activity, Insulin Resistance, and Diabetes" Professor of Medicine Division of Gerontology and Geriatric Medicine Department of Internal Medicine Harborview Medical Center University of Washington Seattle, Washington
"Physiological Responses to Structured Versus Lifestyle Activities" Professor Emeritus of Applied Physiology Department of Preventive Medicine and Biostatistics School of Physical and Health Education University of Toronto Health Studies Programme Brock University Toronto, Ontario, Canada
"Agency for Health Care Policy and Research Clinical Practice Guideline: Cardiac Rehabilitation as Secondary Prevention" Medical Director Preventive Medicine Program/Ambulatory Drug Research Department of Cardiology Arizona Heart Institute Phoenix, Arizona
"Physical Activity and Lipid Metabolism" Senior Research Scientist Stanford Center for Research in Disease Prevention Department of Medicine Stanford University School of Medicine Palo Alto, California
"Are There Cardiovascular Risks Associated With Physical Activity?" Professor of Medicine Division of Cardiology Department of Medicine University of Pittsburgh Medical Center Pittsburgh, Pennsylvania Planning Committee
Chairperson Coordinator, NHLBI Obesity Education Initiative Office of Prevention, Education, and Control National Heart, Lung, and Blood Institute National Institutes of Health Bethesda, Maryland
Deputy Director for Research on Women's Health Office of Research on Women's Health National Institutes of Health Bethesda, Maryland
Director of Research Director, Epidemiology and Clinical Applications Cooper Institute for Aerobics Research Dallas, Texas
Scientific Group Leader Division of Heart and Vascular Diseases National Heart, Lung, and Blood Institute National Institutes of Health Bethesda, Maryland
Director of Musculoskeletal Research Geriatrics Program National Institute on Aging National Institutes of Health Bethesda, Maryland
Program Analyst Office of Medical Applications of Research National Institutes of Health Bethesda, Maryland
Director Office of Medical Applications of Research National Institutes of Health Bethesda, Maryland
Chief, Endocrinology, Nutrition, and Growth Branch Center for Research for Mothers and Children National Institute of Child Health and Human Development National Institutes of Health Bethesda, Maryland
Director of Communications Office of Medical Applications of Research National Institutes of Health Bethesda, Maryland
Director Office of Prevention, Epidemiology, and Clinical Applications National Institute of Arthritis and Musculoskeletal and Skin Diseases National Institutes of Health Bethesda, Maryland
Chief, Nutritional Sciences Branch Director, Division of Nutrition Research Coordination National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health Bethesda, Maryland
NIH Coordinator for Disease Prevention Office of the Director National Institutes of Health Bethesda, Maryland
Director, Airway Biology and Disease Program Division of Lung Diseases National Heart, Lung, and Blood Institute National Institutes of Health Bethesda, Maryland
Conference and Panel Chairperson Professor and Head Division of Epidemiology School of Public Health University of Minnesota Minneapolis, Minnesota
Associate Director for Prevention, Education, and Control National Heart, Lung, and Blood Institute National Institutes of Health Bethesda, Maryland
Nutritionist, Prevention Scientific Research Group Division of Epidemiology and Clinical Applications National Heart, Lung, and Blood Institute National Institutes of Health Bethesda, Maryland
Professor of Epidemiology, Emeritus Division of Epidemiology Department of Health Research and Policy Stanford University School of Medicine Stanford, California
Chairman, Department of Exercise Science School of Public Health University of South Carolina Columbia, South Carolina
Senior Prevention Policy Advisor Office of Disease Prevention and Health Promotion Washington, District of Columbia
Physiologist and Nurse Scientist Acute and Chronic Illness Branch Division of Extramural Programs National Institute of Nursing Research National Institutes of Health Bethesda, Maryland
Leader, Prevention Scientific Research Group Division of Epidemiology and Clinical Applications National Heart, Lung, and Blood Institute National Institutes of Health Bethesda, Maryland
Director, Research, Planning, and Special Projects President's Council on Physical Fitness and Sports Washington, District of Columbia
Director, Division of Chronic Disease Control and Community Intervention Centers for Disease Control and Prevention Atlanta, Georgia
Director, Worksite Health Promotion Program Office of Disease Prevention Office of the Director National Institutes of Health Bethesda, Maryland
Writer/Editor Office of Prevention, Education, and Control National Heart, Lung, and Blood Institute National Institutes of Health Bethesda, Maryland
Professor and Chairman Department of Physiology East Carolina University School of Medicine Greenville, North Carolina Conference SponsorsOffice of Medical Applications of Research, NIH John H. Ferguson, M.D. Director National Heart, Lung, and Blood Institute Claude Lenfant, M.D. Director Conference CosponsorsNational Institute of Child Health and Human Development Duane F. Alexander, M.D. Director National Institute on Aging Richard J. Hodes, M.D. Director National Institute of Arthritis and Musculoskeletal and Skin Diseases Stephen I. Katz, M.D., Ph.D Director National Institute of Diabetes and Digestive and Kidney Diseases Phillip Gorden, M.D. Director National Institute of Nursing Research Patricia A. Grady, R.N., Ph.D. Director Office of Research on Women's Health Vivian W. Pinn, M.D. Director Office of Disease Prevention, NIH William R. Harlan, M.D. Associate Director Centers for Disease Control and Prevention David Satcher, M.D., Ph.D. Director
BibliographyThe following references were provided by the speakers listed above and were neither reviewed nor approved by the panel.
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