Get ‘Em Movin’ How To Do It

1. www.activelivingresearch.org An Active Living Program supported by The Robert Wood Johnson Foundation and administered by San Diego State University. Get ‘Em Movin’ How To Do It Healthy Mississippi Summit December 17, 2008 James F. Sallis, Ph.D. San Diego State University www.activelivingresearch.org

2. Physical Inactivity—Should We Care? • 200,000 deaths attributed to inactivity in the US • Smoking causes about 435,000 deaths • Alcohol causes about 100,000 deaths • 2 million deaths attributed to inactivity worldwide • 6% of medical costs in Canada, Australia, Switzerland, Netherlands, US • comparable to costs due to tobacco • Inactivity is playing a role in the obesity epidemic and promoting PA can contribute to solutions

3. Promoting exercise has not worked Source: Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System

4. Walking for Transport Is Declining, While the Number of Overweight Adults Is Climbing Based on data from the Nationwide Personal Transportation Survey and the Centers for Disease Control and Prevention.

6. Troiano, MSSE, 2007

7. Domains of Activity: The SLOTH Model Sleep Leisure Occupational Transportation Household

8. Getting People Active Is Not EasyNot Everything Works • Knowledge is not sufficient—people know being active is good for them • Health education classes in school are not enough • Family-based programs for children have not been effective. It is difficult to get parents engaged. • We should use evidence-based strategies so we make the best use of limited resources. CDC’s Community Guide

9. The Political Debate • The Left says • We need to engineer society so it is easy for people to be active • Change environments & policies • The Right says • People can choose to be active • Educate them so they choose wisely • The Evidence says • People need activity-friendly places AND educational/motivational programs

10. A Multi-Level Approach Is Needed Policy Context Physical Environment Social/cultural Individual Biological Psychological Skills

11. Need to Intervene in Several Settings • Neighborhood • Mixed use, connected streets • Transportation facilities • Sidewalks, bike lanes, transit • Recreation facilities • Parks, trails, private facilities, aesthetics • Schools & workplaces • Buildings, recreation facilities, PE

12. Research on Built Environment & Physical Activity Sallis & Kerr. For PCPFS Research Digest. 2007

13. Designing Activity-Friendly Communities

14. Designing for Active Transportation • Walkability • Proximity: Are there places nearby to walk to? • Connectivity: Are there safe and direct ways to make the trip?

15. High walkable, low incomeShopping

16. Low walkable, High incomeResidences

17. Our Heritage of Walkability: Kosciusko

18. The Neighborhood Quality of Life (NQLS) Study: The Link Between Neighborhood Design and Physical ActivityFunded by NHLBI, 2001-2005James SallisBrian SaelensLawrence Frank

19. Accelerometer-based MVPA Min/day in Walkability-by-Income Quadrants Walkability: p =.0002 Income: p =.36 Walkability X Income: p =.57 * Adjusted for neighborhood clustering, gender, age, education, ethnicity, # motor vehicles/adult in household, site, marital status, number of people in household, and length of time at current address.

20. Percent Overweight or Obese (BMI>25) in Walkability-by-Income Quadrants Walkability: p =.007 Income: p =.081 Walkability X Income: p =.26 * Adjusted for neighborhood clustering, gender, age, education, ethnicity, # motor vehicles/adult in household, site, marital status, number of people in household, and length of time at current address.

21. Neighborhood Walkability and Active Commuting to School 201 parents reported on children aged 4 to 17 Active commuting to school: 25% in hi-walkable neighborhoods 11% in lo-walkable neighborhoods Parent concerns, mostly about traffic, were higher in lo-walkable neighborhoods Kerr, et al. MSSE, 2006

22. Walkable neighborhoods encourage more walking in older adults Older women who live within walking distance of trails, parks or stores recorded significantly higher pedometer readings than women who did not. The more destinations that were close by, the more they walked. Photo: Michael Ronkin, ODOT King, W., Am. J. of Public Health 2003

23. Handy et al. J Am Plan Assoc 2008. National Surveys.

24. Walkability > Driving > Obesity? Lopez Zetina 2006

25. People with access to parks & recreation Facilities are more likely to be active

26. Access to Recreation Facilities Related to MVPA & Overweight in Youth Gordon Larsen Pediatr 2006

27. Myron Floyd Observed Physical Activity in Park Activity Zones (Chicago) Energy Expenditure (Kkcal/kg/min) Scheffe’s post hoc test Chicago, F = 10.20, p < .001

28. Percent being active with high and low recreational resources within 1 mile of home 55 Low recreational resources High recreational resources 50 45 40 35 30 25 Blacks & Hispanics Non-Hispanic Whites Built Environments May Be More Important for Minorities Diez-Roux 2007

30. Open Schools for Community Use • Schools are in all neighborhoods, and they have space & equipment for PA • Potential for partnerships with PA providers • Concerns about liability can be overcome • Boston Schoolyard Initiative is 10-year school-community collaboration (Russ Lopez) • 58 school playgrounds revitalized • Open to community • Joint use agreements between schools & recreation departments are needed

31. Lois Brink, U Colorado Denver Before After

32. What PE is—too often

33. What PE should be

34. All Kids Should Be Active in PE (50% of class time) And Learn Skills

35. SPARK Outcomes • PE specialists>trained classroom teachers> controls • Improved quality of PE instruction • Increased physical activity in PE • Improved cardiorespiratory & muscle fitness • Improved sports skills • Positive impact on academic achievement • Students enjoyed SPARK lessons • SPARK is now serving 1 million kids/day

36. Elementary schools Middle schools High schools CATCH SPARK M-SPAN (SPARK) TAAG LEAP Evidence-based PE is Available

37. School Environment Interventions • Stratton et al. from the UK conducted several studies showing simple markings on elementary playgrounds increases PA about 18 min/day • Verstraete from • Belgium showed • Equipment at • Recess increased • PA

38. Walking/Cycling to School • Decreased 37% from 1977 to 1995 • Current rates are 5% to 14% • More children walked when there were sidewalks (Ewing, 2004) • Evaluations of Safe Routes to Schools program in California shows investments to improve safety can increase walking & biking to school • Sidewalks • Pedestrian crossings • Traffic calming

39. After-School Programs • Up to 70% of daily PA in after-school hours • Tom Robinson’s Dance for Health showed after-school program can be effective, especially for minority girls

40. How Will We Know When Mississippi Is Serious About Physical Activity? • State health department funding of PA promotion staff • Public health participation in planning and transportation decisions • Zoning law reforms • Higher % of transportation funds go to walking & cycling facilities • Park designs that accommodate communities’ physical activity preferences & programs available in low income communities • Building designs that encourage the routine use of stairs • Well funded PE that ensures students are active on a regular basis • Regularly seen ads that promote physical activity on television and other media—like Mississippi’s Walking

41. Vision for The Future Less of this More of this www.drjamessallis.sdsu.eduwww.activelivingresearch.org

42. The challenge for governments:Connecting the silos transport Planning/ housing education

43. Multi-Level Physical Activity Promotion Framework for Governments Change Mechanisms Initiators Leaders Strategies Outcomes Communications, Mass media Psychological Individual Inter- agency Task force, Broad Coalition, Work Groups -Mission- Physical Activity (Recreation Transportation), Obesity, Injuries, Air Quality Evidence-based programs & Policies in schools, worksites, Community orgs, health care Organizations Local Coalitions, Events, Communications, Mass media Social Cultural Capacity & resources for change Implementation of strategies Policies Urban planning & design, Transportation facilities, Recreation facilities, Zoning, Building codes Built Environment -Money- Health care Costs, Infrastructure Costs Incentives Population-Specific Strategies and Community Participation Research and Evaluation