In the 20th in a series of assessments of Healthy People 2010, Acting Assistant Secretary for Health Cristina Beato chaired a focus area Progress Review on Physical Activity and Fitness. In emphasizing its transcendent importance, Dr. Beato noted that virtually all individuals can benefit from regular physical activity, whether they exercise vigorously or participate in a moderate activity, such as walking. Even moderate activity can reduce substantially the risk of developing or dying from heart disease, diabetes, colon cancer, or high blood pressure. Moreover, at a time when more than two-thirds of Americans are overweight or obese, physical activity plays a role of crucial public health importance in helping to prevent weight gain and promote the maintenance of weight loss. Dr. Beato was assisted by staff of the co-lead agencies for this Healthy People 2010 focus area—the Centers for Disease Control and Prevention (CDC) and the President’s Council on Physical Fitness and Sports (PCPFS). Also participating were representatives of other Department of Health and Human Services (HHS) agencies and offices, as well as the Department of Education and the Department of Agriculture.
The complete text for the Physical Activity and Fitness focus area of Healthy People 2010 is available at www.healthypeople.gov/document/html/volume2/22physical.htm. The meeting agenda, tabulated data for all focus area objectives, charts, and other materials used in the Progress Review can be found at
www.cdc.gov/nchs/about/otheract/hpdata2010/focusareas/fa22-paf.htm.
Data Trends
Richard Klein of CDC’s National Center for Health Statistics presented an overview of data trends in the focus area. He noted that, despite worsening national trends in overweight and obesity, there has been little or no change since the past decade in the status of most objectives for Physical Activity and Fitness. Since the 1997 baselines, modest improvements have been recorded for two objectives: (1) a smaller proportion of the adult population reports pursuing no leisure-time physical activity Obj. 22-1) and (2) a larger proportion of adults performs physical activities that enhance muscular strength and endurance (Obj. 22-4). In 2002, 38 percent of adults (age-adjusted, aged 18 years and older) engaged in no leisuretime physical activity, compared with 40 percent in 1997. Females were 14 percent more likely to be in this category in 2002 than males. By geographic region, people in the southern and lower midwestern states were generally the least physically active during leisure time. Between 1997 and 2002, there was an 8 percent reduction in this category for individuals aged 65 to 74 years (from 51 percent to 47 percent) and a 10 percent reduction among those aged 45 to 64 (from 42 percent to 38 percent). Among five racial and ethnic groups, Hispanics had the highest rate of being nonphysically active in leisure time; whites had the lowest. Among persons with disabilities, 51 percent reported no leisure-time physical activity in 2002, compared with 34 percent of those without disabilities. The 2010 target is to reduce this proportion to 20 percent for all population groups.
Preliminary age-adjusted data for 2003 show that 33 percent of adults aged 18 years and older engaged regularly in moderate physical activity (i.e., 30+ minutes of moderate activity at least 5 times a week), hardly changed from 32 percent in 1997. The proportion of males who did so in 2003 was 36 percent, compared with 31 percent of females. Data for 2002 show that 22 percent of persons with disabilities engaged in regular, moderate physical activity, compared with 34 percent of persons without disabilities. The target is 50 percent (Obj. 22-2). In 2002, as in 1997, 23 percent of adults (age-adjusted, aged 18 years and older) engaged in vigorous physical activity that promoted cardiorespiratory fitness for 20+ minutes on at least 3 occasions per week. The proportion of males that did so was 27 percent, compared with 20 percent of females. The proportion of persons without disabilities who engaged in vigorous physical activity in 2002 was 25 percent, almost twice that of persons with disabilities (14 percent). The target is 30 percent (Obj. 22-3).
In 2001, 65 percent of students in grades 9 through 12 engaged in vigorous physical activity, the same proportion as in 1999. By gender, the proportions engaging in such activity were 73 percent of males and 57 percent of females. In each of the grades from 10 through 12, the proportion of students who engaged in vigorous physical activity was lower than in the preceding grade. The target for all is 85 percent (Obj. 22-7).
Key Challenges and Current Strategies
In the presentations that followed the data overview, the principal themes were introduced by representatives of the two co-lead agencies—Donna Stroup, Associate Director for Science and Acting Deputy Director of CDC’s National Center for Chronic Disease Prevention and Health Promotion, and PCPFS Executive Director Melissa Johnson. Their remarks and the discussions that followed highlighted a number of obstacles to achieving the objectives, as well as activities under way to meet these challenges, including the following:
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Of the total of 2,391,400 deaths in the United States in 2000, poor diet
and physical inactivity accounted for an estimated 17 percent
(approximately 400,000 deaths).
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In 2000, poor diet coupled with lack of exercise was the second leading
actual cause of death. The gap between this risk factor and tobacco use,
the leading cause, has narrowed substantially over the past decade.
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Measuring levels of fitness by means of the surveillance systems currently
in use poses difficulties because of the lack of a standard methodology;
variances in individuals’ understanding of the terms employed, such as
“physical activity,” “leisure,” and “moderate intensity”; the influence of
the order in which questions are asked; memory lapses; and the potential
bias inherent in self-reported data.
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In a new chapter in the Guide to Community Preventive Services, the Task
Force on Community Preventive Services recommends the following strategies
that demonstrate strong evidence of effectiveness in increasing physical
activity: communitywide campaigns, school-based physical education,
individually adapted behavior-change programs, and creation of or enhanced
access to places for physical activity, combined with informational outreach
activities. Also recommended as effective were “point-of-decision” prompts,
such as motivational signs that encourage people to use the stairs instead
of elevators.
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With support from CDC, the community-based Kidswalk-to-School program aims
to increase opportunities for daily physical activity by encouraging children
to walk to and from school in groups accompanied by adults. The program also
advocates for communities to build partnerships with local authorities and
organizations to create an environment that is supportive of walking and
bicycling to school safely.
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In support of the President’s HealthierUS initiative, HHS and the Departments
of Education and Agriculture collaborated to create the Healthier Children and
Youth Memorandum of Understanding (MOU), which encourages all school-aged
children to adopt healthy eating and physical activity behaviors to curb the
increasing rate of obesity and overweight. In addition, the Secretaries of HHS,
Agriculture, Interior, and Transportation and the Acting Secretary of the Army
signed the Public Health and Recreation MOU, which highlights the benefits of
physical activity and the many opportunities to be active on America’s public lands.
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In fiscal year 2004, CDC will provide funds to 28 states to hire necessary staff
and develop comprehensive nutrition and physical activity plans to prevent and
control obesity and other chronic conditions and diseases.
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The Physical Activity Monitor, a belt-worn device that has been in the field since
January 2003, promises to provide more accurate and comprehensive measurements of
an individual’s physical activity. It automatically records locomotion movement,
duration, and intensity over a 7-day time period, data that will be linked to
interview and other health component data (e.g., body weight, functional status,
and bone status).
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Through the outreach initiative called You Can! Steps to a Healthier Aging Campaign,
the HHS Administration on Aging mobilizes community partnerships to increase the
number of older people who stay active and healthy.
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I Can Do It,You Can Do It! is a collaborative initiative between PCPFS, the HHS
Office on Disability, and many community and nonprofit organizations. It will
encourage physically active lifestyles among young people with disabilities
by pairing them with fit adults who have disabilities.
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VERB It’s what you do is a media campaign that aims to get 9- to 13-year-old
children to become more physically active. An evaluation of results from its
first year of funding demonstrated increases in physical activity of 27
percent among girls, 34 percent among children aged 9 to 10 years, and 25
percent among children from lower middle income levels. The most sedentary
individuals among these groups are the most likely to benefit.
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CDC’s Prevention Research Centers (PRC) program is a national network of 28
academic research centers that engage communities as participants in research
on preventing chronic diseases and their risk factors. Many of these sites
have physical activity as part of their research plans. The newest PRC, at
the University of Iowa, works to remedy poor nutrition and lack of physical
activity among rural residents.
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The President’s Challenge is a physical activity/fitness awards program of
the PCPFS that offers a menu of four programs for people aged 6 years and older,
focusing on active lifestyles and physical fitness. The activity log on the
Web site at
www.presidentschallenge.org can track an individual’s physical
activity participation. In the 2002–2003 school year, about 7 million awards
were disseminated nationally.
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Secretary Tommy G. Thompson challenged HHS employees in the Washington, DC,
Southwest complex to be more physically active through the HHS Steps to a
HealthierUS physical activity campaign. Over 25 percent of the 849 registrants
met the requirement of 30 minutes of activity, 5 days a week for 6 weeks.
Governors have followed suit and challenged their states to be more physically
active. Wisconsin Governor Jim Doyle is the first to use the
www.presidentschallenge.org Web site as a model for the
www.wisconsinchallenge.org Web site to get Wisconsinites on the
path to improved health.
Approaches for Consideration
Participants in the review made the following suggestions for steps to enable further progress toward achievement of the objectives for Physical Activity and Fitness:
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Conduct pilot studies on the efficacy and benefits of extending the school
day to allow for inclusion of periods set aside for physical education and sports.
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Endeavor to adapt models of interventions that have been successful for one
age or population group to a form that can be replicated more generally.
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Because females in most age groups lag behind their male counterparts in
levels of physical activity participation, widen the application of
evidence-based practices in physical activity promotion programs for women
and girls. This range of practices should include attention to communitywide
campaigns, individually adapted behavior change, social support, increased
access to facilities, and the amelioration of inhibiting sociocultural factors.
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Step up training of healthcare providers in how to screen for insufficient
physical activity levels, especially among children, the elderly, people
with disabilities, women, and disadvantaged racial and ethnic groups. Provide
them with proven messages or counseling tactics that encourage their patients
to be more physically active.
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Identify and implement proven intervention strategies for active older adults,
frail elderly, the homebound, and older adults who are disabled. These strategies
should be adapted for use in homes, assisted living communities, and communities
with a large proportion of retirees.
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Promote the development of tools for assessing fitness levels that take cultural
differences into account and that provide language translations of key physical
activity-related terms.
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Encourage facilities to conduct an accessibility review and increase funding
for accessibility enhancement projects for public spaces that are compliant
with the Americans with Disabilities Act.
Contacts for information about Healthy People
2010 focus area 22—Physical Activity and Fitness:
|
Cristina V. Beato,
M.D. Acting Assistant Secretary for Health
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