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Physical
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Our nation's young people are, in large measure, inactive, unfit, and increasingly overweight. Physical inactivity threatens to reverse the decades-long progress in reducing deaths from cardiovascular diseases. Ultimately this could have a devastating impact on our national health care budget.
This report, Promoting Better Health for Young People Through Physical Activity and Sports, from the Secretary of Health and Human Services and the Secretary of Education, and released by the White House, outlines ten strategies to promote health and reduce obesity through lifelong participation in enjoyable and safe physical activity and sports. Included is a bibliography and appendices of helpful materials.
The full report, including the appendices, is available on this site.
Our nation’s young people are, in large measure, inactive, unfit, and increasingly overweight. In the long run, this physical inactivity threatens to reverse the decades-long progress we have made in reducing death from cardiovascular diseases and to devastate our national health care budget. In the short run, physical inactivity has contributed to an unprecedented epidemic of childhood obesity that is currently plaguing the United States. The percentage of young people who are overweight has doubled since 1980.
Enhancing efforts to promote participation in physical activity and sports among young people is a critical national priority.
Physical
activity has been identified as one of our nation’s leading health
indicators in Healthy People 2010, the national health objectives for the
decade. Enhancing efforts to promote participation in physical activity and
sports among young people is a critical national priority. That is why,
on June 23, 2000, President Clinton issued an Executive Memorandum
directing the Secretary of Health and Human Services and the Secretary of
Education to work together to identify and report within 90 days on “strategies
to promote better health for our nation’s youth through physical
activity and fitness.” The President concluded his directive: “By
identifying effective new steps and strengthening public-private
partnerships, we will advance our efforts to prepare the nation’s young
people for lifelong physical fitness.”
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To increase their levels of physical activity and fitness, young people can benefit from
StrategiesThe following strategies are all designed to promote lifelong participation in enjoyable and safe physical activity and sports.
ImplementationFull implementation of the strategies recommended in this report will require the commitment of resources, hard work, and creative thinking from many partners in federal, state, and local governments; nongovernmental organizations; and the private sector. Only through extensive collaboration and coordination can resources be maximized, strategies integrated, and messages reinforced. Development or expansion of a broad, national coalition to promote better health through physical activity and sports is an important first step toward collaboration and coordination. A foundation to support the promotion of physical activity could complement the work of the coalition and play a critical role in obtaining the resources needed to help our young people become physically active and fit. The 10 strategies and the process for facilitating their implementation described in this report provide the framework for our children to rediscover the joys of physical activity and to incorporate physical activity as a fundamental building-block of their present and future lives. Introduction
The consequences of the sedentary lifestyles lived by so many of our young people are grave. In the long run, physical inactivity threatens to reverse the decades-long progress we have made in reducing death and suffering from cardiovascular diseases. A physically inactive population is at increased risk for many chronic diseases, including heart disease, stroke, colon cancer, diabetes, and osteoporosis. In addition to the toll taken by human suffering, surges in the prevalence of these diseases could lead to crippling increases in our national health care expenditures. In the short run, physical inactivity has contributed to an unprecedented epidemic of childhood obesity that is currently plaguing the United States. The percentage of young people who are overweight has doubled since 1980.1 Of children aged 5 to 10 who are overweight, 61% have one or more cardiovascular disease risk factors, and 27% have two or more.2 The negative health consequences linked to the childhood obesity epidemic include the appearance in the past two decades of a new and frightening public health problem: type 2 diabetes among adolescents. Type 2 diabetes was previously so rarely seen in children or adolescents that it came to be called “adult-onset diabetes.” Now, an increasing number of teenagers and preteens must be treated for diabetes and strive to ward off the life-threatening health complications that it can cause. Obesity in adolescence also has been associated with poorer self-esteem and with obesity in adulthood. Among adults today, 25% of women and 20% of men are obese.3 The total costs of diseases associated with obesity have been estimated at almost $100 billion per year, or approximately 8% of the national health care budget.4 In January 2000 the nation issued Healthy People 2010,5 its health objectives for the decade. Unlike previous sets of national health objectives, Healthy People 2010 included a set of leading health indicators—10 high-priority public health areas for enhanced public attention. The fact that the first leading health indicator is physical activity and the second is overweight and obesity speaks clearly to the national importance of these issues. Enhancing efforts to promote participation in physical activity and sports among young people is a critical national priority. That is why, on June 23, 2000, President Clinton issued a directive to the Secretary of Health and Human Services and the Secretary of Education to work together to identify and report within 90 days on “strategies to promote better health for our nation’s youth through physical activity and fitness” (Appendix 1). The President instructed the Secretaries to include in this report strategies for
Furthermore, the President directed the Secretaries to work with the United States Olympic Committee (USOC) and other private and nongovernmental sports organizations, as appropriate. The President concluded his directive by saying: “By identifying effective new steps and strengthening public-private partnerships, we will advance our efforts to prepare the nation’s young people for lifelong physical fitness.” BackgroundBenefitsof Physical Activity
The Surgeon General’s report made clear that the health benefits of physical activity are not limited to adults. Regular participation in physical activity during childhood and adolescence
Although research has not been conducted to conclusively demonstrate a direct link between physical activity and improved academic performance, such a link might be expected. Studies have found participation in physical activity increases adolescents’ self-esteem and reduces anxiety and stress.6 Through its effects on mental health, physical activity may help increase students’ capacity for learning. One study found that spending more time in physical education did not have harmful effects on the standardized academic achievement test scores of elementary school students; in fact, there was some evidence that participation in a 2-year health-related physical education program had several significant favorable effects on academic achievement.8 Participation in physical activity and sports can promote social well-being, as well as physical and mental health, among young people. Research has shown that students who participate in interscholastic sports are less likely to be regular and heavy smokers or use drugs,9 and are more likely to stay in school and have good conduct and high academic achievement.10 Sports and physical activity programs can introduce young people to skills such as teamwork, self-discipline, sportsmanship, leadership, and socialization. Lack of recreational activity, on the other hand, may contribute to making young people more vulnerable to gangs, drugs, or violence. One of the major benefits of physical activity is that it helps people improve their physical fitness. Fitness is a state of well-being that allows people to perform daily activities with vigor, participate in a variety of physical activities, and reduce their risks for health problems. Five basic components of fitness are important for good health: cardiorespiratory endurance, muscular strength, muscular endurance, flexibility, and body composition (percentage of body fat). A second set of attributes, referred to as sport- or skill-related physical fitness, includes power, speed, agility, balance, and reaction time. Although skill-related fitness attributes are not essential for maintaining physical health, they are important for athletic performance or physically demanding jobs such as military service and emergency and rescue service. How Much Physical Activity and Fitness Do Young People Need?The Surgeon General’s report on physical activity and health6 concluded that
Rigorous scientific reviews have led to two widely accepted sets of developmentally appropriate recommendations—one for adolescents, the other for elementary school-aged children—for how much and what kinds of physical activity young people need. The International Consensus Conference on Physical Activity Guidelines for Adolescents11 issued the following recommendations:
The developmental needs and abilities of younger children differ from those of adolescents and adults. The National Association for Sport and Physical Education (NASPE) has issued physical activity guidelines for elementary school-aged children12 that recommend the following:
Healthy People 2010,5 the national initiative that established health objectives for the first decade of this century, includes objectives to increase levels of moderate and vigorous physical activity among adolescents, to increase the proportion of trips made by walking and bicycling, and to decrease the amount of time young people spend watching television (Appendix 3). Furthermore, Healthy People 2010 includes participation in physical activity as one of the nation’s 10 leading health indicators. Of the two objectives that will be used to measure progress in meeting this indicator, one targets adolescents:
Healthy People 2010 does not specify national objectives related to youth fitness in part because there is no scientific consensus on which of the various existing fitness tests and classification standards to use. However, there is widespread agreement that fitness tests should emphasize health-related fitness components and that standards for interpreting test results should be based on the relationship between physical activity and health rather than on the results of other students (i.e., norms). This will give all children and adolescents the opportunity to experience success, reinforce the link between fitness and health, and emphasize that one can be fit without being an elite athlete. The importance of physical activity is reinforced in the 2000 version of the Dietary Guidelines for Americans,13 which forms the basis of all federal nutrition education and promotion activities. One of the guidelines advises Americans to “be physically active each day”; children and teens are advised to aim for at least 60 minutes of moderate physical activity most days of the week, preferably daily. How Active and Fit Are Our Children and Adolescents?Available data indicate that young children are among the most active of all segments of the population, but physical activity levels begin to decline as children approach their teenage years and continue to decline throughout adolescence. Even among children and adolescents, however, a substantial proportion of the population does not meet recommended levels of participation in physical activity. The Centers for Disease Control and Prevention’s (CDC’s) Youth Risk Behavior Surveillance System (YRBSS; Appendix 4) collects data on participation in physical activity from a nationally representative sample of students in grades 9�. YRBSS data for 199914 show that, among U.S. high school students:
National transportation surveys have found that walking and bicycling by children aged 5� dropped 40% between 1977 and 1995.15 More than one-third (37%) of all trips to school are made from one mile away or less, but only 31% of these trips are made by walking.16 Although an estimated 38 million young people participate in youth sports programs, participation declines substantially as children progress through adolescence.17 One study found that attrition from youth sports programs was occurring among 10-year-olds and peaked among 14�-year-olds.17 One factor contributing to low levels of physical activity among young people might be the many hours that they spend doing sedentary activities, most notably using electronic media. A 1999 national survey found that young people aged 2� spend, on average, over 4 hours a day watching television, watching videotapes, playing video games, or using a computer. Most of this time—2 hours and 46 minutes per day, on average—is spent watching television. One-third of children and adolescents watch television for more than 3 hours a day, and nearly one-fifth (17%) watch more than 5 hours of television a day.18
The last nationally representative study of youth fitness was conducted in the mid-1980s, but it did not classify students based on whether or not they met health-related fitness standards. However, fitness tests administered throughout California in 1999 found that only about one in five students in the fifth, seventh, and ninth grades met the standards for all health-related fitness components and that more than 40% did not meet the minimum fitness standard for cardiorespiratory endurance.19 How Our Society Discourages Physical ActivityBehavior is shaped, in large measure, by one’s environment. Our young people live in a social and physical environment that makes it easy to be sedentary and inconvenient to be active. Developments in our culture and society over the past few decades that have discouraged youth physical activity include the following:
Strategies
To obtain the opportunities and motivation that will enable them to increase their levels of physical activity and fitness, young people can benefit from
The strategies presented in this report are all designed to promote lifelong participation in enjoyable and safe physical activity. Special efforts must be made to ensure that programs are responsive to those in greatest need, including girls and racial/ethnic minorities. Girls are significantly less likely than boys to participate regularly in vigorous physical activity and on sports teams. Among high school students in 1999, 57% of girls participated regularly in vigorous physical activity compared with 72% of boys, and 49% of girls played on a sports team compared with 62% of boys.14 Despite the tremendous gains girls have made in sports participation during the last 30 years—no doubt due, in large measure, to the 1972 Title IX legislation that prohibited sex discrimination in school athletics—the ratio of female to male participants in interscholastic sports is still only 3:5.17 Girls join organized sports programs at later ages than boys and drop out at younger ages.17 In its 1997 report, Physical Activity and Sport in the Lives of Girls,20 the President’s Council on Physical Fitness and Sports (PCPFS) concluded that physical activity has an increasingly important role in the lives of girls, because of both its physical and emotional health benefits. Strategies to increase the amount of physical activity for boys and girls will need to be different, because girls tend to prefer different types of physical activity and pursue it for different reasons than do boys. Since girls are more likely to have lower self-esteem related to their physical capabilities, programs that serve girls should provide instruction and experiences that increase their confidence, offer ample opportunities for participation, and establish social environments that support involvement in a range of physical activities. Among high school students in 1999, whites were significantly more likely than blacks to report regular participation in physical activity (67% vs. 56%) and more likely than Hispanics to play on sports teams in and out of school (57% vs. 51%).14 Establishing a physically active lifestyle in adolescence is particularly important for African-Americans and Hispanics, because African-American and Hispanic adults are at increased risk for physical inactivity, obesity, and diabetes; African-American adults also are at increased risk for death from heart disease.5 Resources must be invested in creative, culturally sensitive, linguistically appropriate programs to give all young Americans the opportunities and motivation they need to become more active. ImplementationImplementing strategies to promote physical activity and sports participation will require the commitment of resources from federal, state, and local governments and the private sector, as well as close collaboration among health, education, and youth-serving organizations. National efforts to implement and sustain activities to promote youth participation in physical activity and sports would benefit from the establishment or enhancement of a coordinating mechanism, such as a national coalition. To measure the progress of a national initiative and guide its management, national systems should be supported to monitor youth physical activity and fitness and programs designed to promote youth physical activity. To help inform policymakers about the importance of this issue, researchers need to document the effects of participation in physical activity and sports on desired public health and social outcomes, particularly improved academic performance and reductions in youth violence. A Call to Action
The following actions should be taken to facilitate the process of implementing the 10 strategies identified in this report:
The Secretary of Health and Human Services and the Secretary of Education can facilitate progress in efforts to promote youth physical activity by providing annual reports to the President on actions taken to implement the strategies identified in this report. Development or expansion of a broad, national coalition to promote better health through physical activity and sports is an important first step toward collaboration and coordination. An effective national coalition will draw public attention to the need for action, educate the public and policymakers about the strategies recommended in this report, and develop coordinated initiatives to implement the strategies. A number of national coalitions currently exist to promote physical activity or fitness (Appendix 28), and a merger of these, or an intensive expansion of participation in one of them, would initiate a national coordinating mechanism. Among the organizations that should be added to such a national coalition are the USOC and the professional sports leagues. A foundation to support promotion of physical activity could complement the work of the coalition and play a critical role in obtaining the resources needed to help our young people become physically active and fit. Physical activity is crucial to our health, happiness, and well-being. The staggering consequences of decreases in physical activity are clear: soaring rates of obesity and diabetes, potential future increases in heart disease, and devastating increases in health care costs. We now have the opportunity to reshape our sedentary society into one that facilitates and promotes participation in physical activity during childhood, throughout adolescence, and into adulthood. The 10 strategies and the process for facilitating their implementation described in this report provide the foundation for our children to rediscover the joys of physical activity and to incorporate physical activity as a fundamental building-block of their present and future lives. AcknowledgementsThis report was prepared by a work group comprising staff from the following offices. Department of Health and Human ServicesCenters for Disease
Control and Prevention
Office of the Secretary, Office of Public Health and Science
President 's Council on Physical Fitness and Sports
Department of EducationOffice of Elementary and Secondary Education
Revised December 2000 References1. National Center for Health Statistics. Health, United States, 2000. With adolescent health chartbook. Online at http://www.cdc.gov/nchs/ 2. Freedman DS, Dietz WH, Srinivasan SR, Berenson GS. The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa heart study. Pediatrics 1999;103:1175-82 3. Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL. Overweight and obesity in the United States: prevalence and trends, 1960-1994. International Journal of Obesity 1998;22(1):39-47. 4. Wolf AM, Colditz GA. Current estimates of the economic cost of obesity in the United States. Obesity Research 1998;6(2):97-106. 5. U.S. Department of Health and Human Services. Healthy people 2010: understanding and improving health. Washington, DC: U.S. Department of Health and Human Services, Government Printing Office, 2000. 6. U.S. Department of Health and Human Services. Physical activity and health: a report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1996. 7. McGinnis JM, Foege WH. Actual causes of death in the United States. Journal of the American Medical Association 1993;270(18):2207-12. 8. Sallis JF, McKenzie TL, Kolody B, Lewis M, Marshall S, Rosengard P. Effects of health-related physical education on academic achievement: project SPARK. Research Quarterly for Exercise and Sport 1999;70(2):127-34. 9. Escobedo LG, Marcus SE, Holtzman D, Giovino GA. Sports participation, age at smoking initiation and the risk of smoking among US high school students. Journal of the American Medical Association 1993;269:1391-5. 10. Zill N, Nord CW, Loomis LS. Adolescent time use, risky behavior and outcomes: an analysis of national data. Rockville, MD: Westat, 1995. 11. Sallis JF, Patrick K. Physical activity guidelines for adolescents: consensus statement. Pediatric Exercise Science 1994;6:302-14. 12. Corbin CB, Pangrazi RP. Physical activity for children: a statement of guidelines. Reston, VA: National Association for Sport and Physical Education, 1998. 13. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Nutrition and your health: dietary guidelines for Americans (5th ed). Washington, DC: U.S. Department of Agriculture and U.S. Department of Health and Human Services, Government Printing Office, 2000. 14. Centers for Disease Control and Prevention. Youth risk behavior surveillance—United States, 1999. Morbidity & Mortality Weekly Report 2000;49(SS-5):1-94. 15. Nationwide Personal Transportation Survey. U.S. Department of Transportation, Federal Highway Administration, Research and Technical Support Center, Lantham, MD: Federal Highway Administration, 1997. 16. Calculations from the 1995 Nationwide Personal Transportation Survey (S. Ham, unpublished data, 2000). 17. Seefeldt VD, Ewing ME. Youth sports in America: an overview. President’s Council on Physical Fitness and Sports Research Digest 1997;2(11):1-12. 18. Kaiser Family Foundation. Kids & media @ the new millenium [monograph]. Menlo Park, CA: Kaiser Family Foundation, November 1999. 19. California Department of Education, Standards and Assessment Division. California physical fitness test 1999: report to the governor and legislature. Sacramento, CA: California Department of Education, 1999. 20. The President’s Council on Physical Fitness and Sports. Physical activity and sport in the lives of girls: physical and mental health dimensions from an interdisciplinary approach. Washington, DC: President’s Council on Physical Fitness and Sports, 1997. 21. Centers for Disease Control and Prevention. Guidelines for school and community programs to promote lifelong physical activity among young people. Morbidity & Mortality Weekly Report 1997;46(RR-6):1-36. 22. Sallis JF, Prochaska JJ, Taylor WC, Hill JO, Geraci JC. Correlates of physical activity in a national sample of girls and boys in grades 4 through 12. Health Psychology 1999;18:410� 23. Johnson J, Deshpande C. Health education and physical education: disciplines preparing students as productive, healthy citizens for the challenges of the 21 st century. Journal of School Health 2000;70(2):66-8. 24. National Association for Sport and Physical Education. Moving into the future: national standards for physical education. Reston, VA: National Association for Sport and Physical Education, 1995. 25. Centers for Disease Control and Prevention. Physical education. From CDC’s 1994 School Health Policies and Programs Study [fact sheet]. Atlanta, GA: Centers for Disease Control and Prevention, 1999. 26. National Association for Sport and Physical Education. Shape of the nation report: a survey of state physical education requirements. Reston, VA: National Association for Sport and Physical Education, 1998. 27. National Association of State Boards of Education. Fit, healthy and ready to learn: a school health policy guide; Part I: physical activity, healthy eating and tobacco-use prevention. Alexandria, VA: National Association of State Boards of Education, 2000. 28. Sallis JF, McKenzie TL, Alcaraz JE, Kolody B, Faucette N, Hovell M. The effects of a 2-year physical education program (SPARK) on physical activity and fitness in elementary school students. American Journal of Public Health 1997;87:1328-34. 29. Beginning Teacher Standards Task Force of the National Association for Sport and Physical Education. National standards for beginning physical education teachers. Reston, VA: National Association for Sport and Physical Education, 1995. 30. National Consortium for Physical Education and Recreation for Individuals with Disabilities. Adapted physical education national standards. Champaign, IL: Human Kinetics, 1995. 31. Centers for Disease Control and Prevention. School health index for physical activity and healthy eating: a self-assessment and planning guide. Atlanta, GA: Centers for Disease Control and Prevention, 2000. 32. Mohnsen B (ed). Concepts of physical education: what every student needs to know. Reston, VA: National Association for Sport and Physical Education, 1998. 33. National Association for Sport and Physical Education. Quality coaches, quality sports: national standards for athletic coaches. Reston, VA: National Association for Sport and Physical Education, 1995. 34. National Intramural Sports Council. Guidelines for school intramural programs. Reston, VA: National Association for Sport and Physical Education, 1995. 35. National School-Age Care Alliance. The NSACA standards for quality school-age care. Boston: National School-Age Care Alliance, 1998. 36. National Association for Sport and Physical Education. Developmentally appropriate practice in movement programs for young children ages 3-5. Reston, VA: National Association for Sport and Physical Education, 1994. 37. U.S. Bureau of the Census, March 1998 CPS, P20-514, Table 6, 1998. Online at http://www.census.gov/prod/99pubs/p20-514u.pdf. 38. DeAngelis K, Rossi R. Schools serving family needs: extended-day programs in public and private schools. Washington, DC: National Center for Education Statistics, 1997. 39. Catalano RF, Loeber R, McKinney KC. School and community interventions to prevent serious and violent offending. Juvenile Justice Bulletin, October 1999:1-12. 40. Rutherford GS, McCormack E, Wilkinson M. Travel aspects of urban form: implications from an analysis of two Seattle area travel diaries. Presented at the TMIP Conference on Urban Design, Telecommunications and Travel Forecasting. 1998. 41. Centers for Disease Control and Prevention. Neighborhood safety and the prevalence of physical inactivity—selected states, 1996. Morbidity & Mortality Weekly Report 1999;48(7):143-146. 42. Carnegie Council on Adolescent Development. A matter of time: risk and opportunity in the out-of-school hours. Recommendations for strengthening community programs for youth. New York, NY: Carnegie Corporation of New York, 1994. 43. U.S. Department of Health and Human Services. National children and youth fitness study. Journal of Physical Education, Recreation, and Dance 1985;56:44-90. 44. U.S. Department of Health and Human Services. National children and youth fitness study II. Journal of Physical Education, Recreation, and Dance 1987;58:49-96. Download InformationThe documents on this page are available in Portable Document Format (PDF). Learn more about viewing and printing these documents with Acrobat Reader.
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America
loves to think of itself as a youthful nation focused on fitness. But
behind the vivid media images of robust runners, Olympic Dream Teams, and
rugged mountain bikers is the troubling reality of a generation of young
people that is, in large measure, inactive, unfit, and increasingly
overweight.
The landmark 1996
Surgeon General’s report, Physical Activity and Health,6
identified substantial health benefits of regular participation in
physical activity, including reducing the risks of dying prematurely;
dying prematurely from heart disease; and developing diabetes, high blood
pressure, or colon cancer 
Physical
inactivity has contributed to the 100% increase in the prevalence of
childhood obesity in the United States since 1980. According to the
National Health and Nutrition Examination Survey (NHANES), between 1976�80
and 1988�94, the percentage of U.S. adolescents (aged 12�) who
were overweight increased from 5.4% to 9.7% of girls and 4.5% to 11.3% of
boys. The changes among young children (ages 6�) in the same period
were similar, rising from 6.4% to 11.0% of girls and from 5.5% to 11.8% of
boys.1
Children and
adolescents in the United States cannot become more physically
active and fit if they don’t have a wide range of accessible, safe, and
affordable opportunities to be active. However, opportunities alone are
not enough: In 21st century America, physical activity is, for the most
part, a voluntary behavior. Our young people, therefore, will
not increase their levels of physical activity and fitness unless they
are sufficiently motivated to do so. Their motivation to be active will
depend on the degree to which they find their physical activity
experiences to be enjoyable. Enjoyment of physical activity, in
turn, will be influenced by the extent to which young people
Full implementation of
strategies recommended in this report will require the commitment of
resources, hard work, and creative thinking from many partners in federal,
state, and local governments; nongovernmental organizations; and the
private sector. Only through extensive collaboration and coordination can
resources be maximized, strategies integrated, and messages reinforced.