Definitions: Health, Fitness,
and Physical Activity
A Note From the Editors
In 1993, with the special assistance
of Chris Spain, Director of Research, Program Planning,
and Special Projects for the Council, we brought back
the President's Council on Physical Fitness and Sports
Research Digest that was originally published by the
Council under the editorship of H. Harrison Clarke.
As young professionals we remember reading the Digest
and admiring the way Dr. Clarke was able to take complex
information and make it simple to understand. We also
remember that Dr. Clarke would bring together information
from multiple sources and synthesize it for use by practitioners.
For this first issue of the new century
we decided follow Dr. Clarke's lead and draw together
definitions of terms commonly used in our field. Over
the past 50 years there has been considerable change
in the definitions of terms such as physical fitness
and even health. New terms have evolved such as wellness
and metabolic fitness. We have asked Dr. Don Franks,
known for his synthesizing abilities, to help us write
this special issue. We dedicate this issue, as we did
our first in 1993, to the memory of Dr. Clarke.
Introduction
H. Harrison Clarke was one of the
first to write extensively about health related physical
fitness. Indeed, we would consider him and his contemporaries
such as Tom Cureton, Wilhelm Raab and Arthur Steinhaus
as the leaders in changing the way we view physical
fitness today. The definition of fitness in 1958, when
the first national youth fitness test was developed
is considerably different from our current definition
of physical fitness. In addition, new terms have been
developed such as metabolic fitness and wellness. Landmark
documents such as the Healthy People series of national
health objectives (U.S. Department of Health & Human
Services, 2000; U.S. Department of Health & Human
Services, 1990; U.S. Department of Health, Education,
& Welfare, 1979) have helped standardize some terms
as have other documents such at the two international
consensus conference volumes (Bouchard, et al., 1990,
1994) and the more recent Surgeon General's Report on
Physical Activity and Health (U.S. Department of Health
& Human Services, 1996). We have drawn from these
and other sources some common current definitions for
key terms in our field. We focus on those terms that
typically reoccur in the Digest from issue to issue.
It is not our intent to suggest that the terms, as defined
in this document, are the only definitions that are
appropriate for use. Neither is it our intent to suggest
that the terms defined in this issue is a comprehensive
list of all relevant terms. Rather, it is our notion
to define some of the most commonly used terms in the
field (and commonly used in the Digest) and to use definitions
that are consistent with experts in our field.
Product vs. Process
For ease of understanding, we have
grouped the definitions in two broad categories: Product
and Process. Products refer to states of being such
as physical fitness, health and wellness. These are
also commonly referred to as outcomes and they are frequently
used as dependent measures in research. Process refers
to behaviors or lifestyles and these are frequently
used as independent measures for research purposes.
Examples of processes or lifestyle behaviors are physical
activity, exercise, sports, dance, etc.
Product Definitions
Physical Fitness
A set of attributes that people have
or achieve relating to their ability to perform physical
activity (U.S. Department of Health & Human Services,
1996).
Comment: The above definition from
Physical Activity and Health: A Report of the Surgeon
General is the most common currently used definition
of physical fitness. It was originally used by Caspersen,
et al. (1985) and has been used extensively by Pate
et al (1995) and Howley and Franks (1997). An alternative
definition that provides additional descriptive information
is also included here. Physical fitness is a state of
well-being with low risk of premature health problems
and energy to participate in a variety of physical activities
(Howley & Franks, 1997). While either is a good
definition, most experts agree that physical fitness
is both multidimensional and hierarchical (Corbin, 1991).
Bouchard, Shephard, and Stephens (1994) presented a
comprehensive model for physical fitness that includes
morphological fitness, bone strength, muscular fitness,
flexibility, motor fitness, cardiovascular fitness,
and metabolic fitness. In this paper we define each
of these fitness components but use a simple multidimensional
hierarchical model (see Figure 1) that is consistent
with recent definitions in the literature (ACSM, 1998;
USDHHS, 1996; USDHHS, 2000).
Physiological
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Health-Related
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Skill-Related
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Sports
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Metabolic
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Body
Composition
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Agility
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Team
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Morphological
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Cardiovascular Fitness
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Balance
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Individual
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Bone Integrity
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Flexibility
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Coordination
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Lifetime
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Other
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Muscular
Endurance
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Power
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Other
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Muscle Strength
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Speed
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Reaction Time
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Other
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Figure 1. Common Physical Fitness
and Fitness Related Terms
Health-Related Physical Fitness
Health-related physical fitness consists
of those components of physical fitness that have a
relationship with good health. The components are commonly
defined as body composition, cardiovascular fitness,
flexibility, muscular endurance, and strength.
Comment: Prior to the last 40 years
the distinction between health-related physical fitness
and skill-related physical fitness was not typically
made. When tests of physical fitness are administered
in school, medical and other settings it is typically
health-related fitness components that are measured.
Typically lab and field tests of health-related fitness
involve some type of performance such as running, stretching,
or doing a specific muscle exercise. Because body composition
(also referred to as relative leanness) is not a performance
measure, some question its inclusion as a component
of health-related physical fitness. Possessing good
health-related fitness is related to lower risk of illness
and improved quality of life.
Body Composition
A health-related component of physical
fitness that relates to the relative amounts of muscle,
fat, bone and other vital parts of the body. (From Surgeon
General's Report on Physical Activity and Health, USDHHS,
1996 as adapted from Corbin and Lindsey, 1994).
Comment: This component of physical
fitness is measured in the laboratory using such measures
as underwater weighing and in the field using skinfold
calipers. There are a variety of other methods of assessing
body composition; also referred to as relative leanness
(Howley and Franks, 1997). As noted previously body
composition is the only non-performance measure among
the health-related physical fitness components.
Cardiovascular Fitness
A health-related component of physical
fitness that relates to ability of the circulatory and
respiratory systems to supply oxygen during sustained
physical activity. (From Surgeon General's Report on
Physical Activity and Health, USDHHS, 1996 as adapted
from Corbin and Lindsey, 1994).
Comment: Cardiovascular fitness is
also referred to as cardiovascular endurance, aerobic
fitness and cardiorespiratory fitness. A Max V•O2
test in the laboratory setting is considered to be the
best measure of cardiovascular fitness. Commonly administered
field tests include the mile run, the 12 minute run,
the 1 mile run, the mile walk, the PACER run for children
and various bicycle, step, and treadmill tests.
Flexibility
A health-related component of physical
fitness that relates to the range of motion available
at a joint. (From Surgeon General's Report on Physical
Activity and Health, USDHHS, 1996 as adapted from Wilmore
and Costill, 1994).
Comment: Some experts specifiy that
flexibility requires range of motion without discomfort
or pain (Howley and Franks, 1997).Flexibility is specific
to each joint of the body, thus there is no general
measurement of flexibility as there is for cardiovascular
fitness. Flexibility is typically measured in the lab
using measurement devices such as a goniometer, flexometer
and in the field with tests such as the sit and reach
and the zipper.
Muscular Endurance
A health-related component of physical
fitness that relates to the muscle's ability to continue
to perform without fatigue. (From Surgeon General's
Report on Physical Activity and Health, USDHHS, 1996
as adapted from Wilmore and Costill, 1994).
Comment: Like flexibility, muscular
endurance is specific in nature. For true assessment
of muscular endurance it would be necessary to test
each major muscle group of the body. Lab and field tests
of muscular endurance are similar and are based on the
number of repetitions that can be performed by the specific
muscle group being tested (example: repetitions of push-ups
or abdominal curls. Muscular endurance can be measured
isometrically (static contractions) or isotonically
(dynamic contractions).
Strength
A health-related component of physical
fitness that relates to the ability of the muscle to
exert force. (From Surgeon General's Report on Physical
Activity and Health, USDHHS, 1996 as adapted from Wilmore
and Costill, 1994).
Comment: Like flexibility and muscular
endurance, strength is specific in nature. For true
assessment it would be necessary to test each major
muscle group of the body. Lab and field tests are similar
and involve the assessment of one repetition maximum
(the maximum amount of resistance you can overcome one
time). 1RM tests are typically conducted on resistance
machines. Strength can also be assessed using dynamometers.
Strength can be measured isometrically (static contractions)
or isotonically (dynamic contractions).
Skill-related Physical Fitness
Skill-related physical fitness consists
of those components of physical fitness that have a
relationship with enhanced performance in sports and
motor skills. The components are commonly defined as
agility, balance, coordination, power, speed and reaction
time.
Comment: With the changing focus to
health-related physical fitness those components of
fitness previously included in fitness tests that are
not directly related to improved health were designated
as skill-related physical fitness components. Possession
of skill-related fitness abilities enhances ability
to perform in sports and games but only has an indirect
connection with health. The skill-related components
of fitness are considered to be agility, balance, coordination,
power, speed, and reaction time though some experts
feel that other abilities such as visual tracking should
be included. It is assumed that people who possess skill-related
fitness will be more likely to engage in regular activity
and for this reason will have enhanced health-related
fitness and a lower risk of hypokinetic diseases and
condition (see later definition). Skill-related fitness
components are assessed with performance measures. Such
components as reaction time and speed are considered
by some to be more related to heredity than healthy
lifestyles, especially in children.
Agility
A skill-related component of physical
fitness that relates to the ability to rapidly change
the position of the entire body in space with speed
and accuracy. (From Surgeon General's Report on Physical
Activity and Health, USDHHS, 1996 as adapted from Corbin
and Lindsey, 1994).
Comment: Agility is typically measured
using a shuttle or zig-zag run. Tests of agility are
common as screening tests among sports teams.
Balance
A skill-related component of physical
fitness that relates to the maintenance of equilibrium
while stationary or moving. (From Surgeon General's
Report on Physical Activity and Health, USDHHS, 1996
as adapted from Corbin and Lindsey, 1994).
Comment: Balance is typically measured
using a balance beam or tests that require holding a
stationary posture after changing body positions. Balance
is generally considered to be of two types; static and
dynamic.
Coordination
A skill-related component of physical
fitness that relates to the ability to use the senses,
such as sight and hearing, together with body parts
in performing motor tasks smoothly and accurately. (From
Surgeon General's Report on Physical Activity and Health,
USDHHS, 1996 as adapted from Corbin and Lindsey, 1994).
Comment: Coordination is typically
assessed using measures of hand-eye or foot-eye coordination
such as juggling, dribbling a ball or hitting an object.
There are, however, many different types of coordination
and total assessment of coordination would require many
different tests.
Power
A skill-related component of physical
fitness that relates to the ability to the rate at which
one can perform work. (From Surgeon General's Report
on Physical Activity and Health, USDHHS, 1996.)
Comment: Power is considered to be
a combination of strength and speed. It has also been
defined as the ability to exert muscle force quickly
(Howley and Franks). For this reason some consider it
to be a combination of skill and health-related physical
fitness. Examples of power include putting the shot
and vertical jumping. There are, however, many different
types of power and total assessment would require many
different tests.
Speed
A skill-related component of physical
fitness that relates to the ability to perform a movement
within a short period of time. (From Surgeon General's
Report on Physical Activity and Health, USDHHS, 1996
as adapted from Corbin and Lindsey, 1994).
Comment: There are many different
types of speed such as running speed, swimming speed,
speed of hand or foot movement to name but a few. Among
athletes a 40 yard dash is often used to measure speed.
There are a wide variety of laboratory measures of speed
that are highly specific to different body parts and
different human movement activities.
Reaction Time
A skill-related component of physical
fitness that relates to the time elapsed between stimulation
and the beginning of the reaction to it. (From Surgeon
General's Report on Physical Activity and Health, USDHHS,
1996 as adapted from Corbin and Lindsey, 1994).
Comment: An example of reaction time
is moving your foot from the accelerator to the brake
pedal when reacting to a situation that requires a person
to stop a car. This example illustrates the fact that
in many cases, the total response time is the more important
variable. Total response time includes stimulus to beginning
of movement (reaction time) to end of movement (movement
time). Like other measures of skill-related fitness
there are many different types of reaction time and
total assessment of reaction time would require many
different tests. Sophisticated timing devices are used
to measure total response time in the lab. Like speed,
reaction time is considered to be a component of fitness
that is greatly influenced by heredity. Note: The authors
of this paper, not Bouchard, et al. (1990) have classified
these as subcomponents of physiological fitness.
Physiological Fitness
Physiological fitness includes non-performance
components of physical fitness that relate to biological
systems that are influenced by one's level of habitual
physical activity. (adapted from Bouchard, et al., 1990).
Comment: The concept of physiological
fitness was introduced in a publication of the first
international consensus statement of current knowledge
of physical activity (Bouchard, et al., 1990). It differentiated
health-related (primarily performance measures) from
non-performance measures. Some of these measures are
defined below. Some of the sub-components of physiological
fitness that have gained acceptance are metabolic fitness,
morphological fitness, and bone integrity.
Metabolic Fitness
The state of metabolic systems and
variables predictive of the risk for diabetes and cardiovascular
disease which can be favorably altered by increased
physical activity or regular endurance exercise without
the requirement of a training-related increase inV•O2max.
(Adapted from the American College of Sports Medicine,
1998).
Comment: Though Depres, et al. (1990,
1991) are first credited with using the term metabolic
fitness it was first used widely after it was described
in the proceedings of the second International Consensus
Conference on Physical Activity, Fitness and Health
(Bouchard, et al, 1994). The use of the term metabolic
fitness in the recent position statement describing
the quality and quantity of physical activity needed
to attain health-related benefits (ACSM, 1998) establishes
it as a major fitness component. The International Consensus
statement noted that metabolic fitness included such
sub-components as blood sugar levels, blood lipid levels,
and blood hormone levels. The reason for the identification
of metabolic fitness as a separate component of fitness
is because "…it is now clear that lower levels of physical
activity (particularly intensity) than recommended (by
this position stand) may reduce the risk for certain
chronic degenerative diseases and improve metabolic
fitness and yet may not be of sufficient quantity or
quality to improve VO2max. (ACSM, 1998)."
Morphological Fitness
A non-performance component of fitness
related to body composition factors such as body circumferences,
body fat content, and regional body fat distribution
(adapted from Bouchard, et al., 1994).
Comment: Morphological fitness measures
are often related to metabolic fitness components. As
noted earlier body composition is often included as
a component of health-related fitness but is also appropriately
considered a component of morphological fitness. Those
measures used to assess body composition are also used
to assess morphological fitness as are measures such
as body mass index, waist circumference, and waist to
hip ratio.
Bone Integrity (Bone Strength)
A non-performance component of fitness
related to bone mineral density.
Comment: Bone strength was identified
as a component of physical fitness in the first International
Consensus Statement (Bouchard, 1990). Because measurement
is expensive and requires special instrumentation and
a high degree of expertise, there are no currently used
field measures that are used extensively. There is general
consensus, however, that bone integrity is related to
habitual physical activity.
Motor Skills
Motor skills are non-fitness abilities
that improve with practice (learning) and relate to
one's ability to perform specific sports and other motor
tasks.
Comment: Though motor skills are not
considered to be part of physical fitness, they are
related to successful performance in physical activity.
Motor skills are sometimes confused with skill-related
fitness abilities. In fact, they are quite different.
Skill-related fitness components enhance one's ability
to learn sports and motor skills quickly and are related
to one's ability to achieve high level performance.
Examples of motor skills are a tennis serve, shooting
a basketball, and kicking a football. A line (See
Figure 1) is used to indicate the fact that motor skills
are not components of physical fitness. There are many
different kinds of motor skills—only those associated
with sports are included in Figure 1.
Health Definitions
Hypokinetic Diseases or Conditions
Hypokinetic diseases are conditions
related to inactivity or low levels of habitual activity.
Comment: The term "hypokinetic" was
coined by Kraus and Raab in their book Hypokinetic Disease
(Kraus & Raab, 1961). This term is now widely accepted
and can be used to describe many of the diseases and
conditions associated with inactivity and poor fitness
such as those conditions outlined in Physical Activity
and Health: A Report of the Surgeon General (USDHSS,
1996).
Health
Health is a state of being associated
with freedom from disease and illness that also includes
a positive component (wellness) that is associated with
a quality of life and positive well-being. (Adapted
from Corbin, Lindsey, & Welk, 2000; Bouchard, et
al., 1990).
Comment: More than 50 years ago the
World Health Organization defined health as more than
freedom from illness, disease, and debilitating conditions.
Recent public health documents (USDHHS, 2000) have acknowledged
the positive component of health (wellness).
Wellness
Wellness is a state of being describing
a state of positive health in the individual and comprising
biological and psyschological well-being as exemplified
by quality of life and a sense of well-being. (Adapted
from Corbin, Lindsey, & Welk, 2000; Bouchard, et
al., 1990; USDHHS, 2000).
Comment: The suggestion by the World
Health Organization that health had a positive component
led to the use of the term wellness. The term wellness
is now widely used to describe the state of being representing
the positive component of health (Corbin, Lindsey &
Welk, 2000; USDHHS, 2000). The Health Goals for the
Nation for the Year 2010 (USDHHS, 2000) uses quality
of life measures such as self-rated health, a healthy
days index, and an activity days indicators of health
and wellness. Other wellness or quality of life indicators
include vitality, hardiness, and vigor. For more information
on the assessment of health and wellness the reader
is referred to Caspersen, et al., 1995).
Quality of Life
A term that connotes an overall sense
of well being. (USDHHS, 2000).
Comment: Kaplan and Bush (1982) introduced
the term health-related quality of life (HRQL). However,
for public health use, two types of global quality of
life are identified: health-related quality of life
and quality of life (not health related). Health related
quality of life is limited to those aspects that can
clearly be shown to affect mental or physical health.
Examples include functional status and well-being. Non-health
related quality of life includes such factors as happiness
and life satisfaction. Individual quality of life is
identified as related to specific people or individuals.
Community quality of life relates to groups of people
or communities (USDHHS, 2000).
Process Definitions
Healthy Lifestyles or Behaviors
There are many healthy lifestyles
or behaviors that contribute to fitness, health and
wellness. In this paper the processes or healthy
lifestyles that are defined relate only to one healthy
lifestyle: physical activity. The importance of other
healthy lifestyles such as nutrition and stress management
is acknowledged but is beyond the scope of this paper.
Physical Activity
Bodily movement that is produced
by the contraction of skeletal muscle and that substantially
increases energy expenditure. (Adapted from USDHHS,
1996; Bouchard, et al., 1990).
Comment: The first International Consensus
statement on physical activity, fitness and health suggested
that physical activity was an umbrella term (see Figure
2) that was that had multiple dimensions. Forms of physical
activity such as exercise, sports, dance (among others)
are considered as sub-categories of physical activity.
Only selected forms of physical activity, including
those defined in the first international consensus statement
are defined here.
Exercise (training)
Exercise is leisure time physical
activity conducted with the intention of developing
physical fitness. (Adapted from Bouchard, et al.,
1990).
Comment: Since the first International
Consensus statement on physical activity, fitness and
health the distinction has been made between physical
activity and exercise noting that exercise is a specific
form of physical activity dedicated to improving physical
fitness. Physical training is another term that is used
as a synonym for exercise.
Leisure Activity
Leisure activity is physical activity
undertaken during discretionary time. (Adapted
from Bouchard, et al., 1990).
Comment: Research in physical activity
often separates leisure physical activity from vocational
activity. Leisure activity includes exercise but all
forms of leisure activities are not exercise.
Concluding Comments
Our purpose in preparing of this issue
of the Digest was to define some of the key terms of
our field. We learned in the closing years of the past
century that new terms have evolved. In this issue of
the Digest we draw on several of the most recent public
documents relating to health and physical activity to
come up with a compendium of terms that can be
used by practitioners. Figure 3 is included here because
it helps to tie together several of the terms defined
in this paper.
The model adapted from the first consensus
on physical activity, fitness and health shows the link
between product and process, as well as the link between
fitness and health and wellness. It also illustrates
the fact that physical activity is not the only factor
that influences fitness, health and wellness. Clearly
fitness, health and wellness are greatly influenced
by factors other than physical activity, such as heredity
(Bouchard, et al., 1990). Figure 3 also illustrates
that other processes (lifestyles or behaviors) also
have an impact on fitness health and wellness, as do
environmental factors and personal attributes. It is
our hope that this synthesis of information will be
helpful in your efforts to promote physical activity
and other healthy lifestyles as a means of improving
fitness, health and wellness in the years ahead.
The President's Council on Physical
Fitness and Sports Research Digest is now available
on-line at http://www.indiana.edu/~preschal.
Please note that the appropriate language
for the citation of this resource is: The President's
Council on Physical Fitness and Sports Research Digest.
Physical Activity and Fitness Quote
"Physical activity is a healthy
lifestyle that is among the most important for
promoting physical fitness, health and wellness."
Guest Authors
Dr. Charles B. Corbin, Ph.D. and Robert
P. Pangrazi, Ph.D.
Arizona State University, Tempe, Arizona
Dr. B. Don Frank, Ph.D.
University of Maryland, College Park, MD
The President's Council on Physical
Fitness and Sports
The President's Council on Physical
Fitness and Sports The President's Council on
Physical Fitness and Sports (PCPFS) was established
in 1956 through an Executive Order by President Dwight
D. Eisenhower as part of a national campaign to help
shape up America's younger generation. Today, the PCPFS
serves as an advisory council to the President and Secretary
of the Department of Health & Human Services on
matters involving physical activity, fitness and sports
to enhance and improve the health of Americans of all
ages.
The PCPFS enlists the active support
and assistance of individual citizens, civic groups,
private enterprise, and voluntary organizations
to promote and improve the physical activity and fitness
of all Americans and to inform the public of the important
link which exists between regular activity and good
health.
Twenty (20) individuals from the sports,
fitness and health fields are appointed by the President
to serve as members of the Council. They are:
Lee Haney, Chairman
Elizabeth Arendt, M.D., St. Paul, MN
Jeff Blatnick, Halfmoon, NY
Ralph Boston, Knoxville, TN
Don Casey, East Rutherford, NJ
Timothy Finchem, Ponte Vedra
Beach, FL
Rockne Freitas, Ed.D., Honolulu, HI
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Zina Garrison, Houston, TX
Jimmie Heuga, Avon, CO
Jim Kelly,
Buffalo, NY
Judith Pinero Kieffer, Los Angeles,
CA
Deborah Slaner Larkin, Pelham, NY
Nikki McCray, Washington, D.C.
Albert Mead III, Atlanta, GA
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Jack Mills,
Columbia, SC
Ellen Hart Peña,
Denver, CO
Ken Preminger,
Atherton, CA
Amber Travsky,
Laramie, WY
Executive Director—
Sandra Perlmutter
Two (2) vacancies
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