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2008 Physical Activity Guidelines for AmericansAt-A-Glance U.S. Department of Health and Human Services
Physical Activity has a Profound Effect Upon Health Physical activity is one of the most important steps people can take for their health. 2
Background Americans are largely inactive. Many opportunities for physical activity have been engineered out of daily life. 3
The Federal Government published comprehensive Physical Activity Guidelines for Americans for the first time in 2008 Physical Activity Guidelines for Americans “ ” 4
Aims of the Physical Activity Guidelines for Americans Stem the tide toward inactivity and its consequences Move toward a prevention oriented society 5
What Is New About the Guidelines? First major science review in more than a decade. Include a range of activity: “The more you do, the more benefits you gain.” Specify a total amount of activity per week. People can design their own way to meet the Guidelines. Address Americans over the age of 6 and specific subgroups. 6
Major Research Findings Regular activity reduces risk of many adverse health outcomes Some activity is better than none Added health benefits generally occur as amount of activity increases Most health benefits require at least 2 hours and 30 minutes (150 minutes) a week of moderate-intensity physical activity 7
Major Research Findings (cont.) Aerobic & muscle-strengthening activity are beneficial Health benefits apply to people of all types, sizes, and ages Health benefits occur for people with disabilities Physical activity can be done safely. Benefits far outweigh possible risks. 8
Benefits of Physical Activity Adults who participate in any amount of physical activity gain some health benefits. A total of 2 hours and 30 minutes (150 minutes) a week of moderate-intensity aerobic activity substantially reduces the risk of many chronic diseases and other adverse health outcomes. As a person moves from 2 hours and 30 minutes (150 minutes) a week toward 5 hours (300 minutes) a week, he or she gains additional health benefits. 9
Does Everyone Need the Same Amount of Physical Activity? The amount and type of activity needed depends on: age; and special conditions Many choices—“Be Active Your Way” means meeting the guidelines based on setting personal goals. 10
Key Guidelines – Children and Adolescents (ages 6–17) 1 hour (60 minutes) or more of daily physical activity that is at least moderate: Most of the 1 or more hours a day should be either moderate- or vigorous-intensity aerobic physical activity. Do vigorous-intensity physical activity at least 3 days a week. 11
Key Guidelines – Children and Adolescents (ages 6-17) (cont.) As part of 1 or more hours of daily physical activity, include muscle-strengthening activities at least 3 days a week. As part of 1 or more hours of daily physical activity, include bone-strengthening activities at least 3 days a week. It is important to encourage young people to participate in physical activities that are age appropriate, enjoyable, and offer variety. 12
Key Guidelines – Adults (ages 18–64) Minimum levels a week 2 hours and 30 minutes (150 minutes) moderate-intensity aerobic activity; or 1 hour and 15 minutes (75 minutes) vigorous-intensity aerobic activity; or An equal combination Muscle-strengthening activities that involve all major muscle groups should be performed on 2 or more days of the week. 13
Key Guidelines – Adults (ages 18–64) (cont.) 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 14
Key Guidelines – Older Adults (ages 65 years and older) Follow adult guidelines. When not possible, be as physically active as abilities and conditions allow. Do exercises that maintain or improve balance if at risk for falling. Those without chronic conditions and symptoms (e.g., chest pain or pressure, dizziness, or joint pain) do not need to consult a health care provider about physical activity. 15
Additional Considerations Other subgroups of the population in the Physical Activity Guidelines for Americans include: Persons with disabilities Women during pregnancy and the postpartum period Adults with selected chronic conditions 16
Physical Activity Guidelines For all individuals, some activity is better than none. More is better. For fitness benefits, aerobic activity should be episodes of at least 10 minutes. Physical activity is safe for almost everyone. The health benefits of physical activity far outweigh the risks. 17
What About Using Daily Activity Instead of Weekly for Adults? The current Guidelines recommend a total amount of aerobic activity time per week. The recommendation of doing 30 minutes of moderate physical activity on 5 days a week is one way to meet the minimum amount recommended. 18
What About Most People Who are Inactive? People Getting Started Should: Do what they can and then look for ways to do more. Pick an activity they like that fits their lifestyle. Get support from friends & family. Gradually build up over time. Add more time, then more days before increasing intensity of activity. 19
How Can You Get Involved? Sign up as a Supporter & help spread the word about the Physical Activity Guidelines. Receive a toolkit filled with outreach information. Be listed as a Supporter on the official Physical Activity Guidelines Web site. 20
For More Information www.health.gov/paguidelines www.healthfinder.gov (Get Active) 21
Physical Activity Guidelines Advisory Committee Evidence of need for different physical activity recommendations based on race/ethnicity and/or SES?
Committee Member/Consultant/Liaison Shiriki Kumanyika, PhD University of Pennsylvania David Brown, PhD Centers for Disease Control Antronette (Toni) Yancey, MD, MPH UCLA School of Public Health
Significance • Racial/ethnic and SES disparities in obesity and chronic disease prevalence are robust • Racial/ethnic disparities persist across SES continuum, though race/ethnicity and SES highly confounded • Physical inactivity and sedentary behavior are implicated in these disparities across population subgroups, but racial/ethnic differences in the contribution of physical activity (PA) to obesity or specific disease outcomes have infrequently been systematically examined.
Adult Obesity: 1988-94 to 1999-2000 Race/Ethnicity 1988-94 Target Total White Female Male Black Female Male Mexican American Female Male 0 10 20 30 40 50 Percent Note: Data are for ages 20 years and over, age adjusted to the 2000 standard population. Obesity is defined as BMI >= 30.0. Black and white exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC. Obj. 19-2
Differences in the energy cost of PA, such that some ethnic groups appear to derive lesser benefits for weight maintenance at the same level of PA because of racial differences in body morphology &, consequently, BMR (e.g., Ravussin et al., 1998) Differences created by the influence of baseline PA, such that different approaches are necessary for ethnic groups having farther to go to reach PA goals, e.g., because of increased difficulty or exertion (e.g., Hunter et al., 2004) Hunter, Weinsier, Zuckerman et al. Int J Obes Relat Metab Disord. 2004 28(9):1111-7. Ravussin, Lillioja, Knowler et al. N Engl J Med. 1988;318(8):467-72. Questions:What types of differences could there be and what would they mean?
Differences created by the influence of baseline physical inactivity or overweight status, such that different approaches are necessary for ethnic groups having farther to go to reach the goal, e.g., because of increased difficulty or exertion (e.g., Hunter et al., 2004) Hunter, Weinsier, Zuckerman et al. Int J Obes Relat Metab Disord. 2004 28(9):1111-7. Questions:What types of differences could there be and what would they mean? (cont.)
Differences in adherence (adoption, maintenance, resumption) to various types of PA, with implications for long-term sustainability and weight stability, as a result of different cultural values and preferences, environmental exposures, and social (in)justice issues (Estabrooks et al., 2003; Wolch et al., 2005; Day, 2006; Yancey et al., 2006b). Day. J Am Planning Assoc 2006; 72(1): 88-99. Estabrooks, Lee, Gyurcsik. Ann Behav Med. 2003;25:100-4. Wolch, Wilson, Fehrenbach. Urban Geography 2005;26(1):4-35. Yancey, Ory, Davis. Am J Prev Med 2006;31(4S):82-91. Questions:What types of differences could there be and what would they mean? (cont.)
Differences in accuracy of measurement of PA, i.e. inability of activity monitoring devices (e.g., device wearing time, equations/algorithms) or survey assessment tools (e.g., definition, interpretation, patterns) to adequately capture range or intensities of activities, such that research studies are unable to discern real differences in energy expenditure (Ainsworth et al., 2000; Whitt et al., 2003; 2004). Ainsworth, Haskell, Whitt et al. Med Sci Sports Exerc. 2000 Sep;32(9 Suppl):S498-504. Whitt M, Kumanyika S, Bellamy S. Amount and bouts of physical activity in a sample of African-American women. Med Sci Sports Exerc. 2003 Nov;35(11):1887-93. Whitt MC, DuBose KD, Ainsworth B, Tudor-Locke C. Walking patterns in a sample of African American, Native American, and Caucasian women: the cross-cultural activity participation study. Health Educ Behav. 2004 Aug;31(4 Suppl):45S-56S. Questions:What types of differences could there be and what would they mean? (cont.)
Literature Review Gibson, Kirk and colleagues (2005): 86% of 231 articles in a meta-analysis of RCTs examining the effects of diet and exercise on weight- and fitness-related outcomes did not report race/ethnicity, compared with 11% and 4%, respectively, failing to report age and gender. Studies that do not report race/ethnicity have overwhelmingly white samples. Gibson, Kirk, LeCheminant et al. BMC Med Res Methodol 2005;5(1):9.
Literature Review Yancey, Kumanyika and colleagues (2004): • 600+ population-based inclusive PA and/or healthy nutrition promotion or obesity control interventions published between 1970 and 2003 • Selection criteria for literature review—US, targeted to ethnic minority group or inclusive of sufficient sample to permit ethnic-specific analyses • Various search strategies identified 23 studies implemented between 1972 and May 2003 • Only 5 articles that targeted a “general audience” presented subgroup analyses by race/ethnicity • 18 studies targeted one or more racial/ethnic minority groups; 9 of these resulted from a single CDC-funded California state health department initiative Yancey, Kumanyika, Ponce et al., Prev Chronic Dis, 2004; 1:1-18 [E-pub].
Lesser Effectiveness of Key Environmental Interventions in Underserved Groups:Culturally unacceptable strategy or poor marketing? Posting of Signs Promoting Stair Usage 1998 • Overall, stair use increased from 4.8% to 6.9%, 7.2%, depending upon which of 2 signs used • Among whites, increased from 5.1% to 7.5%, 7.8% • Among blacks, changed from 4.1% to 3.4%, 5.0% • Among n’l wt, inc from 5.4% to 7.2%, 6.9% • Among overwt, inc from 3.8% to 6.3%, 7.8% 2006 • Sign cult. targeting blacks worked in blacks & whites Andersen, Franckowiak, Snyder et al., Ann Int Med, 1998;129:363-369.
Methods Unwieldy to even find relevant evidence—for example: Energy balance search strategy employed by the CDC generated 236 articles yielded 16, and PubMed generated 400 articles, yielding an additional 8. Criteria—1) targeting an ethnic minority group or including subgroup analyses by ethnicity, not simply treating race/ethnicity as co-variate and adjusting for it; and 2) specifying the racial/ethnic minority groups included in the analyses, not aggregating in the analyses as “non-white;” and 3) having n >30 or at least 30 participants per study arm; and 4) having a “general audience” sample; and, if applicable, 5) physical activity was the dominant intervention component.
Race/ethnicity: Paucity of Evidence Few studies targeting ethnic minorities were population-based, and very few compared racial/ethnic groups. Thus, findings may not be representative even of subgroups with similar socio-demographic characteristics. There were disproportionately few studies of Latinos, currently the largest US minority group, and even fewer studies of American Indians, with their tremendous intra-ethnic heterogeneity from disparate tribal affiliations. There were disproportionately few studies of Asian/ Pacific Islanders, especially given the heterogeneity by national origin. Most were non-domestic, introducing further contextual complexity.
LTPA and CVD in Women Women’s Health Initiative RR Quintile Manson, et al. NEJM. 2002
Change in Aerobic Capacity in Response to Endurance Training HERITAGE Study of Black and White Men and Women %∆ Percent Change in % VO2 max (ml/kg/min) 20 weeks, 3x/week 55-75% VO2 max 30-50 min/session Cycle ergometer N = 435 N = 195 Skinner, et al. JAP.90:1770, 2001
Change in Peak Absolute Oxygen Uptake for Each Exercise Group White Race Yes No Church, T. S. et al. JAMA 2007;297:2081-2091.
Change in Body Weight in Relation to Change in Physical Activity in Black and White Women & Men : CARDIA Subjects with 75 percentile of baseline BMI ∆ Kg/year All P<0.005 ≥200 Exercise Units of Activity/week (about 2 hours/week @ 6+ METS) Schmitz, et al. Int. J. Obesity 24:1475, 2000.
Race/ethnicity: Conclusions • There is insufficient evidence to conclude that PA recommendations should be different for different racial/ethnic or SES groups • Most individuals from ethnic/gender and/or lower SES groups are relatively sedentary and overweight, such that the benefits of integrating small amounts of PA during the workday and school day should be explored because of promising but preliminary practice-based evidence of such benefits as decreased anxiety, weight stabilization, and injury prevention (e.g., Lara et al., 2008; IOM, 2006; Yancey et al., 2006; Mahar et al., 2006; Crawford et al., 2004; Pohjonen & Ranta, 2001; Pronk et al., 1995) Pronk SJ, Pronk NP, Sisco A, Ingalls DS, Ochoa C. Am J Health Promot 1995;9(3):175-8. Crawford, Gosliner et al. Am J Pub Health 2004; 94:1480-1485 Pohjonen T, Ranta R. Prev Med. Jun 2001;32(6):465-475. IOM. Progress in preventing childhood obesity—how do we measure up? Washington D.C.: NAS, 2006. Mahar MT, Murphy SK, Rowe DA, Golden J, Shields AT, Raedeke TD. Med Sci Sports Exerc 2006;38(12):2086-94. Yancey, Lewis, Guinyard et al. Health Prom Prac 2006; 7(3):233S-246S Lara, Yancey, Tapia-Conyer et al. Prev Chr Dis 2008 Jan;5(1):A12 Epub [serial online]
Race/ethnicity: Recommendations • Federally-funded studies should be powered to include sufficient representation of at least one ethnic/minority or lower SES population, with sufficient sample size to permit subgroup analyses by race/ethnicity or SES. Strict exemption criteria should be rigorously applied.
Race/ethnicity: Recommendations • Cultural proficiency of recruitment and retention approaches and adequacy of resources directed toward recruitment and retention should be scrutinized by grant review committee members with special expertise in this area, similar to the separate assessments of adequacy of study methods and analytical approaches by review committee statisticians.
Race/ethnicity: Recommendations • Federal program officers should manage and balance their portfolios to ensure that racial/ethnic differences in PA-related exposures and outcomes are under active investigation, utilizing RFAs and other mechanisms to direct funding toward disparities examination and elimination.
Race/ethnicity: Recommendations • Journals should require reporting of race/ethnicity, gender and SES of sample in the abstract as well as the body of the text. • Subgroup analyses should be requested when sample size is sufficient, and further data dis-aggregation encouraged to examine interactions between socio-demographic characteristics, e.g., gender-ethnicity, SES-ethnicity.
Race/ethnicity: Recommendations • Abstraction databases should include search criteria that permit ascertainment of inclusiveness, i.e. subgroup analyses by race/ethnicity or SES.
Lift Off! LA / Instant Recess™American College of Preventive MedicineFebruary 12, 2009
Disseminating Evidence-Based Intervention: Incorporating brief PA bouts into organizational routine 7 examples in different settings: • 5 “efficacy” local health dept—Fuel Up/Lift Off! LA, LA County state health dept—FitWIC, CA DHS federal agency—Pausa para tu salud, Mexican Ministry school—Take 10!, Energizers, CATCH private corp.—Westinghouse, LL Bean • 2 adoption/implementation CBOs—REACH 2010, Community Health Councils FBOs—Health-e-AME Physical-e-Fit, USC schools/sports stadiums—PAC’s Instant Recess, Padres FriarFit