There are many reasons why individuals might not meet the Physical Activity Guidelines, but one major factor is the physical environment that surrounds them. When people don't have the option to make the healthy choice regarding their participation in physical activities, there is no possible way they can do it.

Over the past several decades, our society has engineered physical activity out of our lifestyles. For example, 13% of children five to fourteen years old usually walked or biked to school in 2009, compared with 48% of students in 1969. For a long time, neighborhoods were being built without regard for pedestrians, putting the needs of the driver first. Safe biking lanes, walking paths that connected places where people wanted to go, and a variety of safe outdoor play spaces were all but engineered out of most built environments. Schools were being put in a position where they had to eliminate physical education, whether for budget reasons or to meet academic goals. Offices were built without bike racks, employee changing areas, or easy to use staircases, further enhancing less physical activity instead of more.

Fortunately, things are starting to change. A healthier communities movement is building across the nation. The Y, along with other national organizations, is leading the way. Since 2004, with support from the Centers for Disease Control and Prevention and other corporate and foundation donors, the Y has engaged leaders in 200 communities in working together to implement strategies that provide opportunities for physical activity.

YMCAs engaged in our Healthier Communities Initiative (pioneering Healthier Communities, Statewide Pioneering Healthier Communities and ACHIEVE) are helping families by giving parents peace of mind when they let their kids walk to school. The initiative is focused on creating safer routes, making streets safe for all users whether they are on foot or on wheels. The organizations strive to keep a generation of kids healthier by working with schools to increase physical education and physical activity during the school day, and making recess periods more active. The initiative also encourages employers to build environments that support activity among their employees. These examples are just the beginning.

How healthy is your community? What are examples of your community's efforts to change the built environment so more people engage in physical activity to meet the PA guidelines? How are you helping people see that their own built environment supports or inhibits meeting these guidelines? What barriers are there, and how can you work with other leaders in your community to collaboratively remove those barriers?

One of my favorite things to do during the summertime when I was in grade school was going to the pool at my community's recreation center. It was convenient because I lived in town and it was a place where I could socialize with friends.

Looking back almost 20 years later, I realize the importance of the recreation center for me and rest of the community. I grew up in a family where I was encouraged and pushed to be active, regardless of my physical disability. Today, children are less physically active, and instead, playing video games and watching TV. As someone who loves various physical activities, I understand the positive impact physical activity has on an individual's physical and mental well-being. I think this is especially true for children with disabilities. One of the biggest issues is the availability of community physical activity programs for children with disabilities.

With the high obesity rate among Americans - even higher in people with disabilities - communities have the responsibility to provide fitness or physical activity programs for people of all abilities. Today, it's amazing to find so many adaptive sports and recreational opportunities available to people with disabilities, while twenty years ago many of these opportunities were non-existent.

Many of these adaptive sport and physical activity programs are run by non-profit organizations, and now park districts are providing programs. However, it's still not enough. Local communities should be collaborating with school districts to provide programs. Disabilities in general are more "visible" and recognizable in mainstream society now. And, people with disabilities who are living in every community have the right to have fitness/physical activity programs be available to them - just like individuals without disabilities.

Besides the availability of community fitness/physical activity programs, there lies another issue - getting the word out to people. One of the complaints among parents and people with disabilities is that they are unaware these kinds of programs exist. One of the reasons why so many individuals with disabilities do not participate in physical activity is because they don't realize they can, and that it's available. Agency outreach activity needs to be expanded.

In order to get people with disabilities to participate in fitness/physical activity programs they need to be available in communities. This would eliminate people having to search for programs, and accessing them would be easy. One challenge that seems to occur is engaging people with disabilities. I believe that the solution starts in communities, and in collaboration with school districts.

In addition, providing inclusive programs, as well as programs for young children, is a great start. By exposing children to fitness/physical activity programs at an early age, they will continue the behavior as they get older, and receive the health benefits from it. The key is to have programs be available and accessible - the community is a perfect place to start!

What are other ways communities can engage people with disabilities to be physically active?

Physical inactivity is a leading cause of death in the U.S. due to heart disease, stroke, diabetes, and cancer.  Physical activity is critical in the prevention of the detrimental effects of aging, obesity (33 to 35% of the US adult population), and chronic illnesses.  The Finnish Medical Society Duodecim, has also documented the importance of physical activity in the prevention, treatment and rehabilitation of diseases  .  Despite well‐documented evidence of the benefits of physical activity, we still have not approached the recommendations of the HHS Physical Activity Guidelines .  

What is the problem?  Approximately 70% of US adults are underactive,  40% of American adults do nothing to exercise, and  50% of individuals who start an exercise program drop out after 6 months.  (SportsEconomics:  Battling Attrition – A Study in Improving Member Retention at Health Club Facilities.  SportsEconomics Perspectives, Issue 3.  2001.)

Barriers to implementation  by physicians include limited time, lack of tools and skills, and lack of reimbursement.   Patient barriers to exercise include lack of time and confidence, presence of an injury, and incomplete/improper information regarding exercise relevance, content and dosing.    Research shows that  exercise advice given by a primary care physician may be effective in increasing physical activity in the short‐term [after two months], but not in the long‐term [after four and twelve months], due to insufficient support, accountability, and implementation strategies.

Who is currently in position?  The health and fitness industry is uniquely positioned to meet the growing need for easily accessible, supportive, and guided fitness venues.  They clearly have a role but  health clubs average a loss of 1 to 6 of every 10 members, and experience a mean attrition rate of 40% annually.,  Furthermore, program planning at most health clubs is targeted towards individuals who have already committed  to making physical activity a habit (which may explain why so many new members drop off).

Who else can help?   Successful exercise among those individuals who see more barriers than benefits to exercise depends on four key provider-driven characteristics:  clear, credible data; specific, attainable goals; directed programming; and appropriate reinforcement/support.

What’s Our Solution?  Conduct Annual Physical Therapist‐based Fitness Physicals to establish objective, norm‐referenced baseline measures of strength, flexibility, postural habits, cardio respiratory fitness, risks for injury, and readiness for change.  Develop individual fitness plans to specifically address findings; provide patient education, support, and ongoing feedback; establish multi‐modal fitness strategies including home exercise, private fitness training, and/or group fitness classes to best fit patient’s lifestyle, level of confidence and commitment, and experience; provide structured accountability and positive re‐enforcement systems.

What is your organization doing to engage communities to be more physically active?

Written by: Jennifer M. Gamboa, DPT, OCS, MTC