slide1
Download
Skip this Video
Download Presentation
Integrating the 2008 Physical Activity Guidelines for American s and the Guide to Community Preventive Services into Adventure Programs

Loading in 2 Seconds...

play fullscreen
1 / 68

Integrating the 2008 Physical Activity Guidelines for Americans and the Guide to Community Preventive Services into Adve - PowerPoint PPT Presentation


  • 304 Views
  • Uploaded on

Integrating the 2008 Physical Activity Guidelines for American s and the Guide to Community Preventive Services into Adventure Programs. Judy Kruger, PhD U.S. Centers for Disease Control and Prevention Division of Nutrition and Physical Activity Physical Activity and Health Branch

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Integrating the 2008 Physical Activity Guidelines for Americans and the Guide to Community Preventive Services into Adve' - Olivia


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1
Integrating the 2008 Physical Activity Guidelines for Americans and the Guide to Community Preventive Services into Adventure Programs

Judy Kruger, PhD

U.S. Centers for Disease Control and Prevention

Division of Nutrition and Physical Activity

Physical Activity and Health Branch

5th Annual Research and Evaluation of Adventure Programming (REAP)

March 20, 2009

Atlanta, GA

objectives
Objectives
  • Why evidence-base?
  • Discuss evidence from 2008 Guidelines
  • Identify evidence from the Community Guide
  • Identify potential strategies to include in adventure programs
why evidence base
Why evidence-base?
  • Based on what we KNOW…rather than what we THINK works
  • Process of planning, implementing and evaluating programs
  • Individual & community
    • gain skills/adopt behaviors
    • improve physical environment
what is evidence proof
What is evidence = proof?
  • Evidence of a health effect
  • Evidence of a program effect
  • Evidence of program design & context

SOME action needed

SPECIFIC program effect

SPECIFIC delivery effect

perceptions
Advantages

Lead to efficient use of resources

Continuity & growth of the program

Common performance measures

Supports quality improvement

Helps establish partnership

Disadvantages

Need to know where to find evidence

Added expense as tools and process are unfamiliar

Program appears standardized instead of tailored

May impact community buy-in

Perceptions
common components
Common components
  • Specific target population
  • Specific, measurable goals
  • Proven benefits
  • Defined program (structure, timeframe, reasoning)
  • Support (staffing skills, facility, equipment)
summary
Summary
  • Evidence-based concepts includes: planning, implementing and evaluating
  • Many advantages and disadvantages
  • Multiple evidence-based components to consider
resources
Resources
  • CDC, Framework for program evaluation in public health. MMWR. 1999 48 (RR-11): 1-40.
  • CDC, Youth Risk Behavior Surveillance System. www.cdc.gov/HealthyYouth/yrbs
  • CDC, Behavioral RiskFactor Surveillance System. www.cdc.gov/brfss
  • RWJF, Active Living by Design – Case studies. www.activelivingbydesign.org
slide9
QUIZ
  • Evidence-based research includes the process of planning, implementing and evaluating programs adapted from testing interventions in order to address health issues at the individual and community level?

A) True

B) False

slide10
QUIZ
  • Which of the following are perceived advantages of EB?

A) Makes it easier to justify funding

B) Facilitates spread of program

C) Supports continuous quality improvement

D) Helps to establish partnership

E) All of the above

slide11
QUIZ
  • Which of the following are common components of EB?

A) Specific target population

B) Specific, measurable goals

C) Proven benefits

D) A and B

E) All of the above

scientifically established benefits of physical activity pa
Scientifically established benefits of physical activity (PA)
  • ↓ risk of dying prematurely
  • ↓ risk of dying from heart disease
  • ↓ risk of developing diabetes
  • ↓ risk of developing high blood pressure
  • Helps ↓ blood pressure in people who already have high blood pressure
  • ↓ risk of developing colon cancer
  • ↓ feelings of depression and anxiety
  • Helps control weight
  • Helps build and maintain healthy bones, muscles, and joints
  • Promotes psychological well-being
2008 physical activity guidelines for americans
2008 Physical Activity Guidelines for Americans
  • First major review of the science on benefits of physical activity in over a decade
  • Complement previous recommendations
  • Information and guidance on the types and amount of physical activity that provide substantial health benefits
slide15

2005 Dietary Guidelines

2008 Physical Activity Guidelines

www.health.gov/DietaryGuidelines

www.health.gov/paguidelines

3 phases products
3 Phases & Products
  • Evidence review (managed by CDC)
    • Database
  • Advisory committee report (expert panel)
    • Federal Advisory Report
  • Writing process (appointed panel)
    • 2008 Physical Activity Guidelines for Americans
2008 guidelines strategy

CDC triaged 14,472 abstracts

CDC reviewed 1,598

papers

FACA developed 650 page report

HHS writing group created 65 page document

2008 Guidelines strategy

Phase I

Phase II

Phase III

phase i evidence review
Phase I Evidence Review
  • Literature review examined original research published since January 1995
  • Health outcome chapters:
    • All-cause mortality, cardio-respiratory, musculoskeletal, functional health, cancer, mental health, adverse events, metabolic, & energy balance
  • Stratified by age groups
    • Children and youth (6-18 years)
    • Adults (19-64 years)
    • Older adults (65 + years)
initial research questions
Initial research questions

Is physical activity (PA) associated with the health outcome of interest [x]?

What dose of PA is associated with [x]?

What level of PA intensity influences [x]?

Do different modes (types) influence [x]?

phase ii advisory committee report
Phase II Advisory Committee Report
  • Utilized literature database to develop consensus on PA & health literature
  • Health outcome chapters:
    • All-cause mortality, cardio-respiratory, musculoskeletal, functional health, cancer, mental health, adverse events, metabolic, & energy balance
  • Additional chapters on understudied populations
    • Persons with disabilities
    • Women during pregnancy and the postpartum period
    • Adults with selected chronic conditions
phase ii advisory committee
Phase II Advisory Committee

William L. Haskell, Stanford University - ChairMiriam Nelson, Tufts University - Vice ChairRod K. Dishman, University of GeorgiaEdward T. Howley, University of TennesseeWendy Kohrt, University of ColoradoWilliam Kraus, Duke UniversityI-Min Lee, Harvard University Anne McTiernan, Fred Hutchinson Cancer CenterKenneth E. Powell, Atlanta GeorgiaRussell R. Pate, University of South CarolinaJudy Regensteiner, University of ColoradoJames Rimmer, University of Illinois, ChicagoAntronette Yancey, UCLA

phase ii advisory committee27
Phase II Advisory Committee

Reviewed existing scientific literature to identify sufficient evidence to develop a comprehensive set of specific physical activity recommendations

phase iii writing process
Phase III Writing Process
  • Strong reliance upon Advisory Committee Report
  • Final product - 8 chapters
  • Fact sheet, toolkits, PowerPoint presentation
children and adolescents ages 6 17
Children and Adolescents (ages 6-17)
  • 1 hour (60 minutes) or more of Aerobic physical activity that is at least moderate:
    • Most of the 1 or more hours a day should be either moderate- or vigorous-intensity PA
    • Do vigorous-intensity PA at least 3 days a week
  • Encourage participation in PA that are:
    • Age appropriate, enjoyable, offer variety
examples of moderate intensity aerobic activities
Examples of moderate-intensity aerobic activities
  • Children
    • Brisk walk, hiking
    • Active recreation (canoeing)
  • Adolescents
    • Brisk walk, hiking
    • Active recreation (canoeing)
    • Yard work such as raking leaves/ bagging leaves
    • Softball, baseball that require catching and throwing
examples of vigorous intensity aerobic activities
Examples of vigorous-intensityaerobic activities
  • Children
    • Active games (tag - running and chasing)
    • Martial arts (karate)
    • Sports (soccer, hockey, basketball, tennis)
  • Adolescents
    • Active games (flag football - running and chasing)
    • Martial arts (karate)
    • Sports (soccer, hockey, basketball, tennis)
    • Vigorous dancing
children and adolescents continued
Children and Adolescents continued
  • As part of 60 minutes of daily activity to include:
    • Muscle-strengthening: Include muscle-strengthening physical activity on at least 3 days of the week
    • Bone-strengthening: Include bone-strengthening physical activity on at least 3 days of the week
examples of muscle strengthening activities
Examples of muscle strengthening activities
  • Children
    • Games (tug-of-war) or climbing (ropes or play-ground)
    • Resistance exercises (body weight or resistance bands)
    • Ropes, tree climb, swinging on bars/equipment
  • Adolescents
    • Climbing (pull-ups, push-ups)
    • Resistance exercises using hand-held

weights or weight machines

    • Swinging on bars/equipment, rope or tree
examples of bone strengthening activities
Examples of bone strengthening activities
  • Children
    • Games (hopscotch)
    • Jumping rope
    • Gymnastics, basketball, volleyball
  • Adolescents
    • Running
    • Hopping, skipping, jumping
    • Jumping rope
    • Gymnastics, basketball, volleyball
youth aerobic physical activity principle
Principle = F I T

F – Frequency

I – Intensity

T – Time/Duration

2008 Guideline = minimum

F – Daily

I – Moderate or Vigorous

T – 60 minutes

Youth aerobic physical activity principle
muscle bone strengthening principles
Muscle strengthening

3 days per week

Bone strengthening

3 days per week

Muscle & bone strengthening principles

As part of the daily 60 minutes to include:

key guidelines adults ages 18 64
Key Guidelines – Adults (ages 18–64)
  • Minimum aerobic activity for health
    • 2 hours and 30 minutes (150 minutes/week) moderate-intensity aerobic activity; or
    • 1 hour and 15 minutes (75 minutes/week) vigorous-intensity aerobic activity; or
    • Equal combination for 150 minutes/week
  • Muscle-strengthening activities that involve all major muscle groups should be performed on 2 or more days of the week
key guidelines adults continued
Key Guidelines – Adults continued
  • For additional health benefits
    • 5 hours (300 minutes) moderate-intensity aerobic activity a week; or
    • 2 hours and 30 minutes (150 minutes) vigorous-intensity aerobic activity a week; or
    • An equivalent combination (150 minutes)
key guidelines older adults ages 64
Key Guidelines – Older adults (ages 64+)
  • The key guidelines for adults apply to older adults with additional qualifying guidelines:
    • Guideline for adults who cannot do 150 minutes/week
    • Balance exercise
    • Only use relative intensity to determine the level of effort
adult aerobic physical activity principle
Principle = F I T

F – Frequency

I – Intensity

T – Time/Duration

2008 Guideline = minimum

F – Weekly

I – Moderate or Vigorous

T – 150 minutes/week

Adult aerobic physical activity principle
flexibility in meeting minimal aerobic 2008 guideline
Flexibility in meeting minimal aerobic 2008 Guideline

Intensity Duration Frequency

Moderate

or ≥ 150 minutes Week

Vigorous

or ≥ 75 minutes Week

Equivalent

Combination ≥ 150 minutes Week

summary43
Summary
  • Most recent scientific review for Americans in the past decade
  • 2008 Guidelines specify a minimum of aerobic PA based on total time per week
  • For children and adolescents the 2008 Guidelines specify 3 days a week of bone & muscle strengthening activity
  • For adults the 2008 Guidelines specify 2 days a week of muscle-strengthening activity
summary44
Summary
  • Avoid inactivity
    • Some activity is better than none
  • Aerobic activity for children & adolescents
    • ≥60 mins/day moderate intensity or equivalent
  • Aerobic activity for adults
    • Substantial health benefits from medium amounts
      • ≥150 mins/week moderate intensity or equivalent
    • More health benefits from high amounts
      • ≥ 300 mins/week moderate intensity or equivalent
resources45
Resources

Office of the Surgeon General Healthy Youth for a Healthy Future, HHShttp://www.surgeongeneral.gov/obesityprevention/index.html

CDC Division of Adolescent and School Health (DASH), HHShttp://www.cdc.gov/HealthyYouth/about/index.htm

CDC DASH Plan to Address Physical Activity, HHS http://www.cdc.gov/HealthyYouth/physicalactivity/pdf/Addressing_Phys_Activity.pdf

OWH Powerful Bones. Powerful Girls.™, HHShttp://www.girlshealth.gov/bones

SmallStep Kids, HHShttp://www.smallstep.gov/kids/flash/index.html

NIH Ways to Enhance Children\'s Activity and Nutrition (We Can!), HHShttp://www.nhlbi.nih.gov/health/public/heart/obesity/wecan

Eat Smart. Play Hard.™, USDAhttp://www.fns.usda.gov/eatsmartplayhard

slide46
QUIZ
  • What is the minimal recommended amount of aerobic physical activity for children and adolescents?

A) 30 minutes every day

B) 60 minutes every day

C) 90 minutes every day

slide47
QUIZ
  • What is the minimal recommended amount of aerobic physical activity for adults?

A) 90 minutes a week

B) 120 minutes a week

C) 150 minutes a week

slide48
QUIZ
  • What is the minimal recommended amount of aerobic physical activity for older adults?

A) 90 minutes a week

B) 120 minutes a week

C) 150 minutes a week

overview of the task force on community preventive services tfcp recommendations

Overview of the Task Force on Community Preventive Services (TFCP) Recommendations

AKA: Community Guide

the community guide a tool for evidence base
The Community Guide: A Tool for Evidence-Base
  • Independent Task Force on Community Preventive Services
  • Population-based prevention strategies
  • Set of recommendations based on systematic reviews of literature
the community guide uses a systematic approach
The Community Guide Uses A Systematic Approach
  • Form team
  • Develop conceptual framework
  • Define, group and select interventions to be evaluated
  • Search for and collect evidence of effectiveness
  • Evaluate quality of studies
  • Summarize evidence
  • Consider economics, feasibility, and harms
  • Translate evidence into recommendations
physical activity conceptual framework
Physical Activity Conceptual Framework

Behavioral

Outcomes

Modifiable

Determinants

Intermediate

Physiological

Outcomes

Health

Outcomes

Interventions

search strategy

6,238 screened

849

retrieved

253 candidates

94 evaluated

Search strategy
what are some strengths of the community guide
What are some strengths of the Community Guide?
  • Systematic review
  • Credible
  • Evidence of effectiveness
  • Sometimes cost effectiveness
  • A good starting point….
what are some limitations of the community guide
What are some limitations of the Community Guide
  • Intervention headings arbitrary
  • Limited to available evidence at the time
  • Not the only consideration; not the only evidence
  • Doesn’t account for different contexts, e.g., history, culture
5 recommended strategies
5 Recommended strategies
  • Recommended, strong evidence:
  • Community wide campaigns
  • Individually-adapted health behavior change programs
  • School-based physical education
  • Social support interventions in community contexts
  • Creation of/enhanced access to places for PA combined with informational outreach
what is the guide to community preventive services community guide
What is the Guide to Community Preventive Services (Community Guide)?
  • Effective population-level strategies to promote physical activity (PA)
  • 3 Intervention categories:
    • Environmental & policy approaches
      • Creation of/enhanced access to places for PA combined with informational outreach
promoting pa environmental and policy approaches
Promoting PA: Environmental and Policy Approaches

The Task Force Strongly Recommended Creation of or enhanced access to places for PA combined with informational outreach

  • Multi-component
  • Built environment – access to trails/facilities, creating walking trails, building exercise facilities nearby
  • Reducing barriers (safety, affordability)
  • Training & incentives (site-specific programs, workshops, seminars)
creation of enhanced access to places for pa combined with informational outreach
Creation of/enhanced access to places for PA combined with informational outreach
  • Community Guide use “places” instead of “facilities” to avoid the implication that physical activity needs a special type of structure.
  • Interventions were not simply about building trails or facilities; many of them also included training, incentives education, risk factor screening or programming to entice and support use of these places for physical activity
results from the systematic reviews
Results from the Systematic Reviews
  • In all 10 studies reviewed, creating or enhancing access to places for physical activity was effective in getting people to exercise more
    • Aerobic capacity: median increase of 5.1% (interquartile interval: 2.8% to 9.6%; 8 study arms)
    • Energy expenditure: median increase of 8.2% (interquartile interval: -2.0% to 24.6%; 3 study arms)
    • Percentage of participants reporting some leisure-time physical activity: median increase of 2.9% (interquartile interval: -6.0% to 8.5%; 4 study arms)
    • Exercise score: median increase of 13.7% (interquartile interval: -1.8% to 69.6%; 6 study arms)
results continued
Results continued
  • Most of the studies also reported weight losses or decreases in body fat among program participants
  • Many of these programs train participants to use exercise equipment, health/fitness programs, and support or buddy systems
  • These interventions were effective among both men and women and in various settings, including industrial plants, universities, federal agencies, and low-income communities
  • If appropriately adapted to the target populations, these interventions should be applicable to diverse settings and groups
resources62
Resources
  • The Guide to Community Preventive Services: What works to promote health? New York, NY: Oxford Press; 2005: 80-113.
  • Kahn EB et al., Am J Prev Med. 2002; 22 (4 Suppl): 73-107.
  • CDC, MMWR, 2001; 50 (RR18) 1-16.
slide63
QUIZ
  • Which of the following Community Guide recommendations are applicable to adventure programs?

A) Creating places to places to be active

B) Enhancing access to places to be active

C) Informational outreach

D) A and B

E) All of the above

slide64
QUIZ
  • The Community Guide recommendation category for the creation or enhanced access to places for physical activity combined with informational outreach activities is?

A) Recommended, strong evidence

B) Recommended, sufficient evidence

C) Insufficient evidence

D) Recommended against due to lack of effect, cost, harms

E) All of the above

implications
Implications
  • Awareness of scientific evidence
  • Individuals need a flexible and adaptable exercise prescription
  • Translation of efforts are needed to encourage inactive to consider becoming active
  • Need to continue monitoring levels of activity in community
wrap up
Wrap up
  • What are some potential strategies to include in adventure programming?
  • What outcomes have you collected that have demonstrated program effectiveness?
  • How have you used these outcomes to leverage funding?
for more information
For more information

Websites:

www.thecommunityguide.org

http://www.health.gov/paguidelines/

www.cdc.gov/nccdphp/dnpa/physical

for more information68
For more information
  • Websites

www.thecommunityguide.org

http://www.health.gov/paguidelines/

www.cdc.gov/nccdphp/dnpa/physical

ad