22
Physical Activity and Fitness
Co-Lead Agencies:	Centers for Disease Control and Prevention 
President’s Council on Physical Fitness and Sports
Goal
Overview
Issues and Trends
Disparities
Opportunities
Interim Progress Toward Year 2000 Objectives
Healthy People 2010—Summary of Objectives
Healthy People 2010 Objectives
Physical Activity in Adults
Muscular Strength/Endurance and Flexibility
Physical Activity in Children and Adolescents
Access
Related Objectives From Other Focus Areas
Terminology
References

Goal
Improve health, fitness, and quality of life through daily physical activity.
Overview
The 1990s brought a historic new perspective to exercise, fitness, and physical activity by shifting the focus from intensive vigorous exercise to a broader range of health-enhancing physical activities. Research has demonstrated that virtually all individuals will benefit from regular physical activity. A Surgeon General’s report on physical activity and health concluded that moderate physical activity can reduce substantially the risk of developing or dying from heart disease, diabetes, colon cancer, and high blood pressure.1 Physical activity also may protect against lower back pain and some forms of cancer (for example, breast cancer), but the evidence is not yet conclusive., 
Issues and Trends
On average, physically active people outlive those who are inactive., , , ,  Regular physical activity also helps to maintain the functional independence of older adults and enhances the quality of life for people of all ages., , 
The role of physical activity in preventing coronary heart disease (CHD) is of particular importance, given that CHD is the leading cause of death and disability in the United States. Physically inactive people are almost twice as likely to develop CHD as persons who engage in regular physical activity. The risk posed by physical inactivity is almost as high as several well-known CHD risk factors, such as cigarette smoking, high blood pressure, and high blood cholesterol. Physical inactivity, though, is more prevalent than any one of these other risk factors. People with other risk factors for CHD, such as obesity and high blood pressure, may particularly benefit from physical activity.
Regular physical activity is especially important for people who have joint or bone problems and has been shown to improve muscle function, cardiovascular function, and physical performance. However, people with arthritis (20 percent of the adult population) are less active than those without arthritis. People with osteoporosis, a chronic condition affecting more than 25 million people in the United States, may respond positively to regular physical activity, particularly weight-bearing activities, such as walking, and especially when combined with appropriate drug therapy and calcium intake. Increased bone mineral density has been positively associated with aerobic fitness, body composition, and muscular strength.
Although vigorous physical activity is recommended for improved cardiorespiratory fitness, increasing evidence suggests that moderate physical activity also can have significant health benefits, including a decreased risk of CHD. For people who are inactive, even small increases in physical activity are associated with measurable health benefits. In addition, moderate physical activity is more readily adopted and maintained than vigorous physical activity. As research continues to illustrate the links between physical activity and selected health outcomes, people will be able to choose physical activity patterns optimally suited to individual preferences, health risks, and physiologic benefits.
For individuals who do not engage in any physical activity during their leisure time, taking the first step toward developing a pattern of regular physical activity is important. Unfortunately, few individuals engage in regular physical activity despite its documented benefits. Only about 23 percent of adults in the United States report regular, vigorous physical activity that involves large muscle groups in dynamic movement for 20 minutes or longer 3 or more days per week. Only 15 percent of adults report physical activity for 5 or more days per week for 30 minutes or longer, and another 40 percent do not participate in any regular physical activity.
Public education efforts need to address the specific barriers that inhibit the adoption and maintenance of physical activity by different population groups. Older adults, for example, need information about safe walking routes. Persons with foot problems need to learn about proper foot care and footwear in order to reach appropriate activity levels. People with CHD and other chronic conditions must understand the importance of regular physical activity to maintain physical function. Each person should recognize that starting out slowly with an activity that is enjoyable and gradually increasing the frequency and duration of the activity are central to the adoption and maintenance of physical activity behavior. Along with the public education efforts, public programs in a variety of settings (recreation centers, worksites, health care settings, and schools) need to be developed, evaluated, and shared as potential models. The availability of group activities in the community is important for many.
Disparities
Disparities in levels of physical activity exist among population groups. The proportion of the population reporting no leisure-time physical activity is higher among women than men, higher among African Americans and Hispanics than whites, higher among older adults than younger adults, and higher among the less affluent than the more affluent. Participation in all types of physical activity declines strikingly as age or grade in school increases. In general, persons with lower levels of education and income are least active in their leisure time. Adults in North Central and Western States tend to be more active than those in the Northeastern and Southern States. People with disabilities and certain health conditions are less likely to engage in moderate or vigorous physical activity than are people without disabilities. Health promotion efforts need to identify barriers to physical activity faced by particular population groups and develop interventions that address these barriers. 1 

Data demonstrate that major decreases in vigorous physical activity occur during grades 9 through 12. This decrease is more profound for girls than for boys, whether the measure is engaging in vigorous physical activity in general or in team sports. The President’s Council on Physical Fitness and Sports concluded that because of the physical health and emotional benefits of physical activity, it should have an increasingly important role in the lives of girls. Adolescents’ interest and participation in physical activity differ by gender.17 Therefore, strategies to increase the amount of physical activity for boys and girls must address these differences and must begin before the disparities in levels of physical activity manifest themselves. Compared to boys, girls are less likely to participate in team sports but more likely to participate in aerobics or dance. Often girls and boys perceive different benefits from physical activity, with boys viewing such activity as competition and girls as weight management. These factors must be considered in developing programs to address the needs of girls. Because boys are more likely than girls to have higher self-esteem and greater physical strength, programs addressing the needs of girls should provide instruction and experiences that increase their confidence and their opportunities to participate in activities, as well as social environments that support involvement in a range of physical activities.17
Opportunities
The Healthy People 2010 objectives offer opportunities to ensure that physical activity and fitness become part of regular healthy behavioral patterns. Encouraging any type or amount of physical activity in leisure time can provide important health benefits, compared to a sedentary lifestyle.
Activities that promote strength and flexibility are important because they may protect against disability, enhance functional independence, and encourage regular physical activity participation. These benefits are particularly important for older people—a good quality of life means being functionally independent and being able to perform the activities of daily living.
Young people are at particular risk for becoming sedentary as they grow older. Therefore, encouraging moderate and vigorous physical activity among youth is important. Because children spend most of their time in school, the type and amount of physical activity encouraged in schools are important components of a fitness program and a healthy lifestyle.
The major barriers most people face when trying to increase physical activity are time, access to convenient facilities, and safe environments in which to be active. Counseling by primary care providers about the need to participate in physical activity also is an important way to change behavior. In addition, facilities need to be accessible to people with disabilities.
Interim Progress Toward Year 2000 Objectives
Of the 13 physical activity and fitness objectives, 1 has been met—increasing worksite fitness programs. Four objectives show solid gains, indicating that the message about increased physical activity is reaching some segments of the population. The message that a sedentary lifestyle plays a role in both overweight and weight loss needs to be addressed better, as does the role primary care providers can play in counseling individuals to increase their daily activities. Both the quantity and quality of school physical education have slipped. Data to evaluate access and availability of community fitness facilities are not available.
Note: Unless otherwise noted, data are from the Centers for Disease Control and 
Prevention, National Center for Health Statistics, Healthy People 2000 Review, 1998–99.

Healthy People 2010—Summary of Objectives
Goal: Improve health, fitness, and quality of life through daily physical 
activity.

Number	Objective Short Title	
Physical Activity in Adults	
22-1	No leisure-time physical activity	
22-2	Moderate physical activity	
22-3	Vigorous physical activity	
Muscular Strength/Endurance and Flexibility	
22-4	Muscular strength and endurance	
22-5	Flexibility	
Physical Activity in Children and Adolescents	
22-6	Moderate physical activity in adolescents	
22-7	Vigorous physical activity in adolescents	
22-8	Physical education requirement in schools	
22-9	Daily physical education in schools	
22-10	Physical activity in physical education class	
22-11	Television viewing	
Access	
22-12	School physical activity facilities	
22-13	Worksite physical activity and fitness	
22-14	Community walking	
22-15	Community bicycling	

Healthy People 2010 Objectives
Physical Activity in Adults
22-1.	Reduce the proportion of adults who engage in no 
leisure-time physical activity.
Target: 20 percent.
Baseline: 40 percent of adults aged 18 years and older engaged in no leisure-time physical activity in 1997 (age adjusted to the year 2000 standard population).
Target setting method: Better than the best.
Data source: National Health Interview Survey (NHIS), CDC, NCHS.
Adults Aged 18 Years and Older, 1997	No Leisure-Time Physical Activity	
	Percent	
TOTAL	40	
Race and ethnicity	
American Indian or Alaska Native	46	
Asian or Pacific Islander	42	
Asian	42	
Native Hawaiian and other Pacific Islander	41	
Black or African American	52	
White	38	
	
Hispanic or Latino	54	
Not Hispanic or Latino	38	
Black or African American	52	
White	36	
Gender	
Female	43	
Male	36	
Education level (aged 25 years and older)	
Less than 9th grade	73	
Grades 9 through 11	59	
High school graduate	46	
Some college or AA degree	35	
College graduate or above	24	
Geographic location	
Urban	39	
Rural	43	
Disability status	
Persons with disabilities	56	
Persons without disabilities	36	
Select populations	
Age groups	
18 to 24 years	31	
25 to 44 years	34	
45 to 64 years	42	
65 to 74 years	51	
75 years and older	65	
Persons with arthritis symptoms	43	
Persons without arthritis symptoms	38	

DNA = Data have not been analyzed. DNC = Data are not collected. DSU = Data are statistically unreliable.
Note: Age adjusted to the year 2000 standard population.
22-2.	Increase the proportion of adults who engage regularly, preferably daily, in moderate physical activity for at least 30 minutes per day.
Target: 30 percent.
Baseline: 15 percent of adults aged 18 years and older engaged in moderate physical activity for at least 30 minutes 5 or more days per week in 1997 (age adjusted to the year 2000 standard population).
Target setting method: Better than the best.
Data source: National Health Interview Survey (NHIS), CDC, NCHS.
Adults Aged 18 Years and Older, 1997	22-2.
30 Minutes of 
Activity 5 or More 
Days per Week	20 Minutes of 
Activity 3 or More 
Days per Week*	
	Percent	
TOTAL	15	31	
Race and ethnicity	
American Indian or Alaska Native	13	25	
Asian or Pacific Islander	15	30	
Asian	15	30	
Native Hawaiian and other Pacific 
Islander	11	31	
Black or African American	10	23	
White	15	32	
	
Hispanic or Latino	11	23	
Not Hispanic or Latino	15	32	
Black or African American	10	22	
White	16	33	
Gender	
Female	13	30	
Male	16	31	
Education level (aged 25 years and older)	
Less than 9th grade	7	13	
Grades 9 through 11	11	21	
High school graduate	14	28	
Some college or AA degree	17	34	
College graduate or above	17	38	
Geographic location	
Urban	15	31	
Rural	15	30	
Disability status	
Persons with disabilities	12	23	
Persons without disabilities	16	33	
Select populations	
Age groups	
18 to 24 years	17	36	
25 to 44 years	15	31	
45 to 64 years	14	30	
65 to 74 years	16	31	
75 years and older	12	23	
Persons with arthritis symptoms	15	29	
Persons without arthritis symptoms	15	32	

DNA = Data have not been analyzed. DNC = Data are not collected. DSU = Data are statistically unreliable.
Note: Age adjusted to the year 2000 standard population.
*Data for 20 minutes of activity 3 or more days per week are displayed to further characterize the issue.
22-3.	Increase the proportion of adults who engage in vigorous physical activity that promotes the development and 
maintenance of cardiorespiratory fitness 3 or more days per week for 20 or more minutes per occasion.
Target: 30 percent.
Baseline: 23 percent of adults aged 18 years and older engaged in vigorous physical activity 3 or more days per week for 20 or more minutes per occasion in 1997 (age adjusted to the year 2000 standard population).
Target setting method: Better than the best.
Data source: National Health Interview Survey (NHIS), CDC, NCHS.
Adults Aged 18 Years and Older, 1997	Vigorous Physical Activity	
	Percent	
TOTAL	23	
Race and ethnicity	
American Indian or Alaska Native	19	
Asian or Pacific Islander	17	
Asian	16	
Native Hawaiian and other Pacific Islander	24	
Black or African American	17	
White	24	
	
Hispanic or Latino	16	
Not Hispanic or Latino	24	
Black or African American	17	
White	25	
Gender	
Female	20	
Male	26	
Education level (aged 25 years and older)	
Less than 9th grade	6	
Grades 9 through 11	12	
High school graduate	18	
Some college or AA degree	24	
College graduate and above	32	
Geographic location	
Urban	24	
Rural	21	
Disability status	
Persons with disabilities	13	
Persons without disabilities	25	
Select populations	
Age groups	
18 to 24 years	32	
25 to 44 years	27	
45 to 64 years	21	
65 to 74 years	13	
75 years and older	6	
Persons with arthritis symptoms	21	
Persons without arthritis symptoms	24	

DNA = Data have not been analyzed. DNC = Data are not collected. DSU = Data are statistically unreliable.
Note: Age adjusted to the year 2000 standard population.

The adoption and maintenance of regular physical activity represent an important component of any health regime and provide multiple opportunities to improve and maintain health. Because the highest risk of death and disability is found among those who do no regular physical activity, engaging in any amount of physical activity is preferable to none. Physical activity should be encouraged as part of a daily routine. While moderate physical activity for at least 30 minutes a day is preferable, intermittent physical activity also increases caloric expenditure and may be important for those who cannot fit 30 minutes of sustained activity into their daily schedules. For even greater health benefits, vigorous physical activity is necessary. For most persons, the greatest opportunity for physical activity is associated with leisure time, because few occupations today provide sufficient vigorous or moderate physical activity to produce health benefits.
Engaging in moderate physical activity for at least 30 minutes per day will help ensure that sufficient calories are used to provide health benefits. A minimum level of intensity (for example, a brisk walk for 30 minutes per day) would, for most persons, result in an energy expenditure of about 600 to 1,100 calories per week. If calorie intake remains constant, this expenditure translates into a weight loss of roughly one-sixth to one-third pound per week. Increases in daily activity to ensure a weekly expenditure of 1,000 calories would have significant individual and public health benefit for CHD prevention and deaths from all causes, especially for persons who are sedentary. Furthermore, this level of activity is feasible for most people even though the relative intensity of any activity will vary by age. Starting out slowly and gradually increasing the frequency and duration of physical activity is the key to successful behavior change. In the case of walking, the message becomes, “If you are not used to daily walking, then walk slowly and take short, frequent walks, gradually increasing distance and speed.”
Muscular Strength/Endurance and Flexibility
22-4.	Increase the proportion of adults who perform physical 
activities that enhance and maintain muscular strength 
and endurance.
Target: 30 percent.
Baseline: 18 percent of adults aged 18 years and older performed physical 
activities that enhance and maintain strength and endurance 2 or more days per week in 1998 (age adjusted to the year 2000 standard population).
Target setting method: Better than the best.
Data source: National Health Interview Survey (NHIS), CDC, NCHS.
Adults Aged 18 Years and Older, 1998 (unless noted)	Strengthening and Endurance 
Exercises	
	Percent	
TOTAL	18	
Race and ethnicity	
American Indian or Alaska Native	18	
Asian or Pacific Islander	17	
Asian	17	
Native Hawaiian and other Pacific Islander	19	
Black or African American	16	
White	18	
	
Hispanic or Latino	13	
Not Hispanic or Latino	18	
Black or African American	15	
White	19	
Gender	
Female	14	
Male	21	
Education level (aged 25 years and older)	
Less than 9th grade	4	
Grades 9 through 11	8	
High school graduate	11	
Some college or AA degree	19	
College graduate and above	26	
Geographic location	
Urban	19	
Rural	15	
Disability status	
Persons with disabilities 	14 (1997)	
Persons without disabilities	20 (1997)	
Select populations	
Age groups	
18 to 24 years (not age adjusted)	28	
25 to 44 years (not age adjusted)	21	
45 to 64 years (not age adjusted)	14	
65 to 74 years (not age adjusted)	10	
75 years and older (not age adjusted)	7	
Persons with arthritis symptoms	18	
Persons without arthritis symptoms	18	

DNA = Data have not been analyzed. DNC = Data are not collected. DSU = Data are statistically unreliable.
Note: Age adjusted to the year 2000 standard population.
22-5.	Increase the proportion of adults who perform physical 
activities that enhance and maintain flexibility.
Target: 43 percent.
Baseline: 30 percent of adults aged 18 years and older did stretching exercises in the past 2 weeks in 1998 (age adjusted to the year 2000 standard population).
Target setting method: Better than the best.
Data source: National Health Interview Survey (NHIS), CDC, NCHS.
Adults Aged 18 Years and Older, 1998 (unless noted)	Stretching 
Exercises	
	Percent	
TOTAL	30	
Race and ethnicity	
American Indian or Alaska Native	26	
Asian or Pacific Islander	34	
Asian	34	
Native Hawaiian and other Pacific Islander	42	
Black or African American	26	
White	30	
	
Hispanic or Latino	22	
Not Hispanic or Latino	31	
Black or African American	27	
White	31	
Gender	
Female	30	
Male	30	
Family income level	
Below poverty	21	
Near poverty	24	
Middle/high income	34	
Education level (aged 25 years and older)	
Less than high school	16	
High school graduate	23	
At least some college	36	
Geographic location	
Urban	32	
Rural	25	
Disability status	
Persons with activity limitations	29 (1995)	
Persons without activity limitations	31 (1995)	
Select populations	
Age groups	
18 to 24 years	36	
25 to 44 years	32	
45 to 64 years	28	
65 to 74 years	24	
75 years and older	22	
Persons with arthritis symptoms 	DNA	
Persons without arthritis symptoms 	DNA	

DNA = Data have not been analyzed. DNC = Data are not collected. DSU = Data are statistically unreliable.
Note: Age adjusted to the year 2000 standard population.

All adults could benefit from physical activities designed to ensure functional independence throughout life. The specific physical fitness components that provide continued physical function as persons age include muscular strength/endurance and flexibility. Examples of these activities include weight training, resistance activities (using elastic bands or dumbbells), and stretching exercises (such as static stretching, yoga, or T’ai Chi Chuan). 
Effective treatment of many chronic diseases and disorders has resulted in more years of life, but many of these extra years are spent with disabling conditions that prevent independent living and reduce the quality of life. Strengthening activities, while important for all age groups, are particularly important for older adults. Muscle strength declines with age, and there is a demonstrated relationship between muscle strength and physical function. Age-related loss of strength may be lessened by strengthening exercises, enabling an individual to maintain a threshold level of strength necessary to perform basic weight-bearing activities, such as walking.,  Strength training also has been shown to preserve bone density in postmenopausal women.9
Physical activities that improve muscular strength/endurance and flexibility also improve the ability to perform tasks of daily living and may improve balance, thus preventing falls.1 Activities of daily living have been identified as a scale to measure dependencies in basic self-care and other functions important for independent living and to avoid institutionalization. The performance of routine daily activities is particularly important to maintaining functional independence and social integration in older adults.11
Although flexibility may appear to be a minor component of physical fitness, the consequence of rigid joints affects all aspects of life, including walking, stooping, sitting, avoiding falls, and driving a vehicle. Lack of joint flexibility may adversely affect quality of life and will lead to eventual disability. Activities such as static stretching or T’ai Chi Chuan routines, which consist of slow, graceful movements with low impact, have great promise for maintaining flexibility and can be appropriate for adults of any age. Increasing public awareness of all these potential benefits of muscle strengthening and flexibility activities—and developing and making quality programs available and accessible—may encourage the pursuit of activities that promote muscular strength/endurance and flexibility.
Physical Activity in Children and Adolescents
22-6.	Increase the proportion of adolescents who engage 
in moderate physical activity for at least 30 minutes on 
5 or more of the previous 7 days.
Target: 35 percent.
Baseline: 27 percent of students in grades 9 through 12 engaged in moderate physical activity for at least 30 minutes on 5 or more of the previous 7 days in 1999. 
Target setting method: Better than the best.
Data source: Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.
Students in Grades 9 
Through 12, 1999 (unless noted)	Moderate Physical Activity	
	22-6.
Both 
Genders	Females*	Males*	
	Percent	
TOTAL	27	24	29	
Race and ethnicity	
American Indian or Alaska 
Native	DSU	DSU	DSU	
Asian or Pacific Islander	DSU	DSU	DSU	
Asian	DSU	DSU	DSU	
Native Hawaiian and other Pacific Islander	DSU	DSU	DSU	
Black or African American	17	17	24	
White	27	27	31	
	
Hispanic or Latino	21	17	26	
Not Hispanic or Latino	27	25	30	
Black or African American	21	18	24	
White	29	26	32	
Parents’ education level 	
Less than high school 	25 (1997)	25 (1997)	24 (1997)	
High school graduate 	21 (1997)	20 (1997)	21 (1997)	
At least some college 	20 (1997)	19 (1997)	20 (1997)	
Select populations	
Grade levels	
9th grade	28	26	31	
10th grade	26	25	27	
11th grade	25	21	29	
12th grade	27	24	29	

DNA = Data have not been analyzed. DNC = Data are not collected. DSU = Data are statistically unreliable.
*Data for females and males are displayed to further characterize the issue.
22-7.	Increase the proportion of adolescents who engage in 
vigorous physical activity that promotes cardiorespiratory fitness 3 or more days per week for 20 or more minutes per occasion.
Target: 85 percent.
Baseline: 65 percent of students in grades 9 through 12 engaged in vigorous physical activity 3 or more days per week for 20 or more minutes per occasion 
in 1999.
Target setting method: Better than the best.
Data source: Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP. 

Students in Grades 9 
Through 12, 1999 (unless noted)	Vigorous Physical Activity	
	22-7.
Both 
Genders	Females*	Males*	
	Percent	
TOTAL	65	57	72	
Race and ethnicity	
American Indian or Alaska 
Native	DSU	DSU	DSU	
Asian or Pacific Islander	DSU	DSU	DSU	
Asian	DSU	DSU	DSU	
Native Hawaiian and other Pacific Islander	DSU	DSU	DSU	
Black or African American	56	49	64	
White	68	60	75	
	
Hispanic or Latino	61	50	72	
Not Hispanic or Latino	65	58	73	
Black or African American	56	47	65	
White	67	60	75	
Parents’ education level 	
Less than high school 	50 (1997)	43 (1997)	60 (1997)	
High school graduate 	54 (1997)	45 (1997)	62 (1997)	
At least some college 	68 (1997)	57 (1997)	75 (1997)	
Select populations	
Grade levels	
9th grade	73	68	77	
10th grade	65	56	73	
11th grade	58	49	67	
12th grade	61	52	71	

DNA = Data have not been analyzed. DNC = Data are not collected. DSU = Data are statistically unreliable.
*Data for females and males are displayed to further characterize the issue.
22-8.	Increase the proportion of the Nation’s public and private schools that require daily physical education for all 
students.
Target and baseline:
Objective	Increase in Schools Requiring Daily Physical Activity for All Students	1994 
Baseline	2010 
Target	
		Percent	
22-8a.	Middle and junior high schools	17	25	
22-8b.	Senior high schools	2	5	

Target setting method: 47 percent improvement for middle and junior high schools; 150 percent improvement for senior high schools.
Data source: School Health Policies and Programs Study (SHPPS), CDC, NCCDPHP. 
22-9.	Increase the proportion of adolescents who participate 
in daily school physical education.
Target: 50 percent.
Baseline: 29 percent of students in grades 9 through 12 participated in daily school physical education in 1999.
Target setting method: Better than the best.
Data source: Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.
Students in Grades 9
Through 12, 1999 (unless noted)	Daily School Physical Education	
	22-9.
Both 
Genders	Females*	Males*	
	Percent	
TOTAL	29	26	32	
Race and ethnicity	
American Indian or Alaska 
Native	DSU	DSU	DSU	
Asian or Pacific Islander	DSU	DSU	DSU	
Asian	DSU	DSU	DSU	
Native Hawaiian and other Pacific Islander	DSU	DSU	DSU	
Black or African American	28	25	33	
White	28	26	31	
	
Hispanic or Latino	40	36	45	
Not Hispanic or Latino	28	25	30	
Black or African American	29	26	33	
White	28	26	31	
Parents’ education level 	
Less than high school 	29 (1997)	28 (1997)	30 (1997)	
High school graduate 	24 (1997)	22 (1997)	27 (1997)	
At least some college 	28 (1997)	25 (1997)	30 (1997)	
Select populations	
Grade levels	
9th grade	42	40	44	
10th grade	30	28	33	
11th grade	20	17	24	
12th grade	20	17	24	

DNA = Data have not been analyzed. DNC = Data are not collected. DSU = Data are statistically unreliable.
*Data for females and males are displayed to further characterize the issue.
22-10.	Increase the proportion of adolescents who spend at least 50 percent of school physical education class time being physically active.
Target: 50 percent.
Baseline: 38 percent of students in grades 9 through 12 were physically active 
in physical education class more than 20 minutes 3 to 5 days per week in 1999.

Target setting method: Better than the best.
Data source: Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

Students in Grades 9
Through 12, 1999 (unless noted)	Physically Active in Physical 
Education Classes	
	22-10.
Both 
Genders	Females*	Males*	
	Percent	
TOTAL	38	32	45	
Race and ethnicity	
American Indian or Alaska 
Native	DSU	DSU	DSU	
Asian or Pacific Islander	DSU	DSU	DSU	
Asian	DSU	DSU	DSU	
Native Hawaiian and other Pacific Islander	DSU	DSU	DSU	
Black or African American	32	24	41	
White	40	33	46	
	
Hispanic or Latino	41	35	47	
Not Hispanic or Latino	38	31	45	
Black or African American	32	25	37	
White	40	33	45	
Parents’ education level 	
Less than high school 	28 (1997)	25 (1997)	32 (1997)	
High school graduate	29 (1997)	24 (1997)	35 (1997)	
At least some college 	33 (1997)	27 (1997)	37 (1997)	
Select populations	
Grade levels	
9th grade	55	48	62	
10th grade	41	35	47	
11th grade	29	24	35	
12th grade	24	16	32	

DNA = Data have not been analyzed. DNC = Data are not collected. DSU = Data are statistically unreliable.
*Data for females and males are displayed to further characterize the issue.

22-11.	Increase the proportion of adolescents who view television 2 or fewer hours on a school day.
Target: 75 percent.
Baseline: 57 percent of students in grades 9 through 12 viewed television 2 or fewer hours per school day in 1999.
Target setting method: Better than the best.
Data source: Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.
Students in Grades 9 through 12, 1999	Television 2 or Fewer Hours 
per School Day	
	Percent	
TOTAL	57	
Race and ethnicity	
American Indian or Alaska Native	DSU	
Asian or Pacific Islander	DSU	
Asian	DSU	
Native Hawaiian and other Pacific Islander	DSU	
Black or African American	28	
White	66	
	
Hispanic or Latino	48	
Not Hispanic or Latino	DNA	
Black or African American	26	
White	66	
Gender	
Female	59	
Male	56	
Parents’ education level	
Less than high school	DNC	
High school graduate	DNC	
At least some college	DNC	
Select populations	
Grade levels	
9th grade	49	
10th grade	54	
11th grade	62	
12th grade	67	

DNA = Data have not been analyzed. DNC = Data are not collected. DSU = Data are statistically unreliable.

The health benefits of moderate and vigorous physical activity are not limited to adults. Physical activity among children and adolescents is important because of the related health benefits (cardiorespiratory function, blood pressure control, and weight management) and because a physically active lifestyle adopted early in life may continue into adulthood. Even among children aged 3 to 4 years, those who were less active tended to remain less active after age 3 years than most of their peers. These findings highlight the need for parents, educators, and health care providers to become positive role models and to be involved actively in the promotion of physical activity and fitness in children and adolescents.
Many children are less physically active than recommended, and physical activity declines during adolescence.,  One study found that one-quarter of U.S. children spend 4 hours or more watching television daily. Schools are an efficient vehicle for providing physical activity and fitness instruction because they reach most children and adolescents. Participation in school physical education ensures a minimum amount of physical activity and provides a forum to teach physical activity strategies and activities that can be continued into adulthood. Findings suggest that the quantity and, in particular, the quality of school physical education programs have a significant positive effect on the health-related fitness of children and adolescents by increasing their participation in moderate to vigorous 
activities., 
Studies have shown that spending 50 percent of physical education class time on physical activity is an ambitious but feasible target. Being active for at least half of physical education class time on at least half of the school days would provide a substantial portion of the physical activity time recommended for adolescents. To achieve the benefits of school-based physical education equitably for all children, daily adaptive physical education programs should be available for children with special needs. School physical education requirements also are recommended for students in preschool and postsecondary programs.
Physical education is the primary source of physical activity and fitness instruction. Health education and other courses, however, can highlight the importance of physical activity as a component of a healthy lifestyle. A well-designed health education curriculum can help students develop the knowledge, attitudes, behavioral skills, and confidence needed to adopt and maintain physically active lifestyles.31 To maximize classroom time, instruction on physical activity also can be integrated into the lesson plans of other school subjects, such as mathematics, biology, and language arts. Programs that have included classroom instruction in physical activity have been effective in enhancing students’ physical activity-related knowledge, attitudes, behavior, and physical fitness. (See Focus Area 7. Educational and Community-Based Programs.)
Access
22-12.	(Developmental) Increase the proportion of the Nation’s public and private schools that provide access to their physical activity spaces and facilities for all persons 
outside of normal school hours (that is, before and after the school day, on weekends, and during summer and other vacations). 
Potential data source: School Health Policies and Programs Study (SHPPS), CDC, NCCDPHP.
22-13.	Increase the proportion of worksites offering employer-sponsored physical activity and fitness programs.
Target: 75 percent.
Baseline: 46 percent of worksites with 50 or more employees offered physical activity and/or fitness programs at the worksite or through their health plans in 1998–1999.
Worksite Size	Worksite or Health Plan	Health Plan	Worksite 	
	Percent	
Total (50 or more employees)	46	22	36	
50 to 99 employees	38	21	24	
100 to 249 employees	42	20	31	
250 to 749 employees	56	25	44	
750 or more employees	68	27	61	
Less than 50 employees	Developmental	

Target setting method: Better than the best.
Data source: National Worksite Health Promotion Survey, Association for 
Worksite Health Promotion (AWHP).
Participation in regular physical activity depends, in part, on the availability and proximity of community facilities and on environments conducive to physical activity. Studies of adult participation in physical activity have found that use generally decreases as facility distance from a person’s residence increases. People are unlikely to use community resources located more than a few miles away by car or more than a few minutes away by biking or walking. 
One of the major barriers to youth participation in sports is lack of enough sports facilities. Increased access to community physical activity facilities would, therefore, help increase youth physical activity. The availability of school facilities for physical activity programs also may be beneficial for crime and violence prevention and other social programs,37 because most juvenile crime is committed between 3 and 8 p.m. 
Schools need to work with community coalitions and community-based physical activity programs to take maximum advantage of school facilities for the benefit of children and adolescents and the community as a whole. The needs of all community members, including senior citizens and people with disabilities, need to be considered.
Worksite physical activity and fitness programs provide a mechanism for reaching large numbers of adults and have at least short-term effectiveness in increasing the physical activity and fitness of program participants. Such programs should be provided in a culturally and linguistically competent manner. Evidence that worksite programs are cost-effective is growing. Such programs may even reduce employer costs for insurance premiums, disability benefits, and medical expenses. Additional benefits for employers include increased productivity, reduced absenteeism, reduced employee turnover, improved morale, enhanced company image, and enhanced recruitment. Including family members and retirees in worksite programs can further increase benefits to employers and the community.39 
As purchasers of group health and life insurance plans, employers can design employee benefit packages that include coverage for fitness club membership fees and community-based fitness classes. Employers also can offer reduced insurance premiums and rebates for employees who participate regularly in worksite fitness programs or who can document participation in regular physical activity.

22-14.	Increase the proportion of trips made by walking.
Target and baseline:
Objective	Increase in Trips 
Made by Walking	Length of Trip	1995
Baseline*	2010
Target	
		                               Percent	
22-14a.	Adults aged 18 years and older	Trips of 1 mile 
or less	17	25	
22-14b.	Children and adolescents 
aged 5 to15 years	Trips to school of
1 mile or less	31	50	

*Age adjusted to the year 2000 standard population.

Target setting method: 47 percent improvement for 22-14a and 68 percent improvement for 22-14b. (Better than the best will be used when data are available.)
Data source: Nationwide Personal Transportation Survey (NPTS), DOT. 
Adults Aged 18 Years and Older, 1995	22-14a.
Trips of 1 Mile or Less Made by Walking 
	
	Percent	
TOTAL	17	
Race and ethnicity	
American Indian or Alaska Native	DNC	
Asian or Pacific Islander	DNC	
Asian	DNC	
Native Hawaiian and other Pacific Islander	DNC	
Black or African American	DNC	
White	DNC	
	
Hispanic or Latino	DNC	
Not Hispanic or Latino	DNC	
Black or African American	DNC	
White	DNC	
Gender	
Female	17	
Male	16	
Education level 	
Less than high school	20	
High school graduate	14	
At least some college	18	
Geographic location	
Urban	18	
Rural	9	
Select populations	
Age groups	
18 to 24 years	22	
25 to 44 years	17	
45 to 64 years	14	
65 to 74 years	16	
75 years and older	19	

DNA = Data have not been analyzed. DNC = Data are not collected. DSU = Data are statistically unreliable.
Note: Age adjusted to the year 2000 standard population.

Children and Adolescents Aged 5 to 15 Years, 1995	22-14b.
Trips to School of 1 Mile or Less Made by Walking 
	
	Percent	
TOTAL	31	
Race and ethnicity	
American Indian or Alaska Native	DNC	
Asian or Pacific Islander	DNC	
Asian	DNC	
Native Hawaiian and other Pacific Islander	DNC	
Black or African American	DNC	
White	DNC	
	
Hispanic or Latino	DNC	
Not Hispanic or Latino	DNC	
Black or African American	DNC	
White	DNC	
Gender	
Female	27	
Male	35	
Parents’ education level 	
Less than high school	DNC	
High school graduate	DNC	
At least some college	DNC	
Geographic location	
Urban	32	
Rural	27	
Select populations	
Age groups	
5 to 9 years	27	
10 to 15 years	35	

DNA = Data have not been analyzed. DNC = Data are not collected. DSU = Data are statistically unreliable.
Note: Age adjusted to the year 2000 standard population.

Walking is a very popular form of physical activity in the United States; however, people need the opportunity to walk safely. Over 75 percent of all trips less than 1 mile were made by automobile in 1995. In addition, the number of walking trips as a percentage of all trips taken (of any distance) has declined over the years. Walking trips made by adults dropped from 9.3 percent in 1977 to 7.2 percent in 1990 and again to 5.4 percent in 1995. Walking has declined even more sharply for children.40 These declines have negative implications for the health of adults and children.

22-15.	Increase the proportion of trips made by bicycling.
Target and baseline:
Objective	Increase in Trips 
Made by Bicycling	Activity	1995
Baseline*	2010 
Target	
		                          Percent	
22-15a.	Adults aged 18 years and older	Trips of 5 miles 
or less	0.6	2.0	
22-15b.	Children and adolescents 
aged 5 to15 years	Trips to school of
2 miles or less	2.4	5.0	

*Age adjusted to the year 2000 standard population.

Target setting method: 233 percent improvement for 22-15a and 108 percent improvement for 22-15b. (Better than the best will be used when data are 
available.)
Data source: Nationwide Personal Transportation Survey (NPTS), DOT.
Adults Aged 18 Years and Older, 1995	22-15a.
Trips of 5 Miles or Less Made by 
Bicycling 
	
	Percent	
TOTAL	0.6	
Race and ethnicity	
American Indian or Alaska Native	DNC	
Asian or Pacific Islander	DNC	
Asian	DNC	
Native Hawaiian and other Pacific Islander	DNC	
Black or African American	DNC	
White	DNC	
	
Hispanic or Latino	DNC	
Not Hispanic or Latino	DNC	
Black or African American	DNC	
White	DNC	
Gender	
Female	0.3	
Male	0.9	
Education level 	
Less than high school	0.6	
High school graduate	0.5	
At least some college	0.6	
Geographic location	
Urban	0.6	
Rural	0.3	
Age groups	
18 to 24 years	1.4	
25 to 44 years	0.6	
45 to 64 years	0.3	
65 to 74 years	0.3	
75 years and older	0.1	

DNA = Data have not been analyzed. DNC = Data are not collected. DSU = Data are statistically unreliable.
Note: Age adjusted to the year 2000 standard population.

Children and Adolescents Aged 5 to 15 Years, 1995	22-15b.
Trips to School of 2 Miles or Less Made by Bicycling 
	
	Percent	
TOTAL	2.4	
Race and ethnicity	
American Indian or Alaska Native	DNC	
Asian or Pacific Islander	DNC	
Asian	DNC	
Native Hawaiian and other Pacific Islander	DNC	
Black or African American	DNC	
White	DNC	
	
Hispanic or Latino	DNC	
Not Hispanic or Latino	DNC	
Black or African American	DNC	
White	DNC	
Gender	
Female	1.7	
Male	3.2	
Parents’ education level 	
Less than high school	DNC	
High school graduate	DNC	
At least some college	DNC	
Geographic location	
Urban	2.6	
Rural	1.1	
Select populations	
Age groups	
5 to 9 years	1.6	
10 to 15 years	3.0	

DNA = Data have not been analyzed. DNC = Data are not collected. DSU = Data are statistically unreliable.
Note: Age adjusted to the year 2000 standard population.

Bicycling is another form of transportation that may be used by both children and adults for distances that may not be feasible, practical, or efficient to cover by walking. If the environment does not provide safe opportunities for physical activities such as walking and bicycling, adults and children likely will spend more time engaging in sedentary activities indoors. (See Focus Area 8. Environmental Health.) Sedentary activities such as watching television, playing video games, and using personal computers have contributed to increases in the cases of overweight individuals.27

Related Objectives From Other Focus Areas
1.	Access to Quality Health Services
1-2. 	Health insurance coverage for clinical preventive services
1-3. 	Counseling about health behaviors
2.	Arthritis, Osteoporosis, and Chronic Back Conditions
2-2. 	Activity limitations due to arthritis
2-3. 	Personal care limitations
2-8. 	Arthritis education 
2-9. 	Cases of osteoporosis
2-11.	Activity limitations due to chronic back conditions
3.	Cancer
3-5. 	Colorectal cancer deaths
3-7. 	Prostate cancer deaths
3-9. 	Sun exposure and skin cancer
3-10. 	Provider counseling about cancer prevention
4.	Chronic Kidney Disease
4-8. 	Medical therapy for persons with diabetes and proteinuria
5.	Diabetes
5-1.	Diabetes education
5-2.	New cases of diabetes
5-3.	Overall cases of diagnosed diabetes
5-4.	Diagnosis of diabetes
5-5.	Diabetes deaths
5-6.	Diabetes-related deaths 
5-7.	Cardiovascular disease deaths in persons with diabetes
6.	Disability and Secondary Conditions
6-2.	Feelings and depression among children with disabilities
6-3.	Feelings and depression interfering with activities among adults with 
disabilities
6-4.	Social participation among adults with disabilities
6-9.	Inclusion of children and youth with disabilities in regular education 
programs
6-10.	Accessibility of health and wellness programs
6-12.	Environmental barriers affecting participation in activities
6-13.	Surveillance and health promotion programs
7.	Educational and Community-Based Programs
7-2.	School health education
7-3.	Health-risk behavior information for college and university students
7-5.	Worksite health promotion programs
7-6.	Participation in employer-sponsored health promotion activities
7-7.	Patient and family education 
7-9.	Health care organization sponsorship of community health promotion 
activities
7-10.	Community health promotion programs
7-11.	Culturally appropriate and linguistically competent community health 
promotion programs
7-12.	Older adult participation in community health promotion activities
8.	Environmental Health
8-1.	Harmful air pollutants
8-2.	Alternative modes of transportation
8-9.	Beach closings
8-20.	School policies to protect against environmental hazards
9.	Family Planning
9-11.	Pregnancy prevention education
11.	Health Communication
11-1.	Households with Internet access
11-4.	Quality of Internet health information sources
12.	Heart Disease and Stroke
12-1.	Coronary heart disease (CHD) deaths
12-7.	Stroke deaths 
12-9.	High blood pressure
12-10.	High blood pressure control
12-11.	Action to help control blood pressure
12-13.	Mean total blood cholesterol levels
12-14.	High blood cholesterol levels
12-16.	LDL-cholesterol level in CHD patients
15.	Injury and Violence Prevention
15-1.	Nonfatal head injuries
15-2.	Nonfatal spinal cord injuries
15-13.	Deaths from unintentional injuries
15-14.	Nonfatal unintentional injuries
15-16.	Pedestrian deaths
15-18.	Nonfatal pedestrian injuries
15-21.	Motorcycle helmet use
15-23.	Bicycle helmet use
15-24.	Bicycle helmet laws
15-27.	Deaths from falls
15-28.	Hip fractures
15-29.	Drownings
15-31.	Injury protection in school sports
16.	Maternal, Infant, and Child Health
16-3.	Adolescent and young adult deaths
16-12.	Weight gain during pregnancy
17.	Medical Product Safety
17-2.	Linked, automated information systems
17-3.	Provider review of medications taken by patients
17-5.	Receipt of oral counseling about medications from prescribers and 
dispensers
18.	Mental Health and Mental Disorders
18-5.	Eating disorder relapses
18-7.	Treatment for children with mental health problems
18-9.	Treatment for adults with mental disorders
19.	Nutrition and Overweight
19-1.	Healthy weight in adults
19-2.	Obesity in adults
19-3.	Overweight or obesity in children and adolescents
19-16.	Worksite promotion of nutrition education and weight management
20.	Occupational Safety and Health
20-1.	Work-related injury deaths
20-2.	Work-related injuries
20-3.	Overextension or repetitive motion
20-9.	Worksite stress reduction programs
23.	Public Health Infrastructure
23-2.	Public access to information and surveillance data
23-5.	Data for Leading Health Indicators, Health Status Indicators, 
and Priority Data Needs at Tribal, State, and local levels
23-17.	Population-based prevention research
24.	Respiratory Diseases
24-1.	Deaths from asthma
24-2.	Hospitalizations for asthma
24-3.	Hospital emergency department visits for asthma
24-4.	Activity limitations
24-5.	School or work days lost
24-6.	Patient education
24-7.	Appropriate asthma care
25.	Sexually Transmitted Diseases
25-11.	Responsible adolescent sexual behavior
25-12.	Responsible sexual behavior messages on television
26.	Substance Abuse
26-9.	Substance-free youth
26-14.	Steroid use among adolescents
26-17.	Perception of risk associated with substance abuse
26-23.	Community partnerships and coalitions
27.	Tobacco Use
27-1.	Adult tobacco use
27-2.	Adolescent tobacco use
27-3.	Initiation of tobacco use
27-4.	Age at first tobacco use
27-5.	Smoking cessation by adults
27-7.	Smoking cessation by adolescents
28.	Vision and Hearing
28-9.	Protective eyewear
Terminology
(A listing of abbreviations and acronyms used in this publication appears in Appendix H.)
Aerobic: Conditions or processes that occur in the presence of, or requiring, oxygen.
Energy expenditure: The energy cost to the body of physical activity, usually measured in kilocalories.41
Functional independence: The ability to perform successfully and safely activities related to a daily routine with sufficient energy, strength/endurance, flexibility, and coordination.
Physical activity: Bodily movement that is produced by the contraction of skeletal muscle and that substantially increases energy expenditure.1
Moderate physical activity: Activities that use large muscle groups and are at least equivalent to brisk walking. In addition to walking, activities may include swimming, cycling, dancing, gardening and yardwork, and various domestic and occupational activities.
Vigorous physical activity: Rhythmic, repetitive physical activities that use large muscle groups at 70 percent or more of maximum heart rate for age. An exercise heart rate of 70 percent of maximum heart rate for age is about 60 percent of maximal cardiorespiratory capacity and is sufficient for cardiorespiratory conditioning. Maximum heart rate equals roughly 220 beats per minute minus age. Examples of vigorous physical activities include jogging/running, lap swimming, cycling, aerobic dancing, skating, rowing, jumping rope, cross-country skiing, hiking/backpacking, racquet sports, and competitive group sports (for example, soccer and basketball).
Physical fitness: A set of attributes that persons have or achieve that relates to the ability to perform physical activity.1 Performance-related components of fitness include agility, balance, coordination, power, and speed. Health-related components of physical fitness include body composition, cardiorespiratory function, flexibility, and muscular strength/endurance.41
Agility: Ability to start, stop, and move the body quickly and in different directions.
Balance: Ability to maintain a certain posture or to move without falling.
Body composition: The relative amount of body weight that is fat and nonfat.
Cardiorespiratory function: A health-related component of physical fitness that relates to the ability of the circulatory and respiratory systems to supply oxygen during physical activity.
Coordination: Ability to do a task integrating movements of the body and different parts of the body.
Exercise (exercise training): Planned, structured, and repetitive bodily movement done to improve or maintain one or more components of physical fitness.
Flexibility: Ability to move a joint through the full range of motion without discomfort or pain.
Muscular endurance: Ability of the muscle to perform repetitive contractions over a prolonged period of time.
Muscular strength: Ability of the muscle to generate the maximum amount of force.
Power: Ability to exert muscular strength quickly.
Speed: Ability to move the whole body quickly.
Sedentary: Denotes a person who is relatively inactive and has a lifestyle characterized by a lot of sitting.41
References