DNPAO Message Information Session

Increasing Physical Activity:

Guidance Document Strategies

State Nutrition, Physical Activity

And Obesity Program

Annual Training Meeting

March 18, 2010

Guidance DocumentBackground

• Purpose:

To help guide the selection of intervention strategies from among the many available

• What the document is not:

It is not meant to be prescriptive. It is not all-inclusive, and the levels of evidence vary.

• How were the strategies selected?

Each guidance document used the highest level of evidence available for the recommended strategies.

Physical Activity Guidance Document

• How were the physical activity strategies selected?

Eight strategies are recommendations of the U.S. Task Force on Community Preventive Services.

Two additional evidence-based strategies were selected on the basis of scientific evidence or expert panel recommendations.

So………why is it important to promote physical activity?

• Health benefits

• Physical activity guidelines

• Physical activity prevalence

•30% risk reduction in all cause mortality

•20-35% lower risk for CVD, CHD, Stroke

•30-40% lower risk of type 2 diabetes

•30% lower risk of colon cancer, 20% lower for breast cancer

•20-30% lower risk for depression, distress and dementia

•36-68% lower hip fracture risk

Physical Activity Health Benefits

Weight-related Benefits ofPhysical Activity

Weight Stability•Regular PA provides benefits for weight stability

Weight Regain•More PA is better to help prevent regain of lost weight

Weight Loss•More than 5% of body weight difficult without reduced calorie intake

PA Recommendations: Adults

• All adults should avoid inactivity, adults who participate in any activity gain some health benefits

• 150 minutes of moderate-intensity activity or 75 minutes of vigorous, or a combination of both, per week.

• For additional and more extensive benefits, do 300 minutes of moderate or 150 minutes of vigorous per week

Children and adolescents should do 60 minutes (1 hour) or more of physical activity daily.

• Aerobic: Most of the 60 or more minutes a day should be either moderate- or vigorous-intensity aerobic physical activity, and should include vigorous-intensity physical activity at least 3 days a week.

• Muscle-strengthening: As part of their 60 or more minutes of daily physical activity, children and adolescents should include muscle-strengthening physical activity on at least 3 days of the week.

• Bone-strengthening: As part of their 60 or more minutes of daily physical activity, children and adolescents should include bone-strengthening physical activity on at least 3 days of the week.

Children and Adolescents

Reported Total Weekly Aerobic Physical Activity – BRFSS, 2007

22.0%

45.9%

18.6%13.5%

0

10

20

30

40

50

60

70

80

90

100

Highly Active (>300min/wk)

Active (150-299min/wk)

Insufficiently Active(10-149 min/wk)

Inactive (<10min/wk)

Pre

va

len

ce

64% Meet 2008 PAG 35.5% Not Meeting 2008

Recommended Physical Activity Intervention Strategies

• Three broad domains align with levels of behavioral influence:

– Informational

– Social and Behavioral

– Environmental and Policy Top three – potential reach and impact

Strategy 1: *Community-wide Campaigns

Strong evidence• Large scale, high visibility campaigns• Mass media messages• Support through various sectors in the targeted

community• Emphasis on policy and environmental change

*One of the top three recommended strategies

Strategy 2: *Create or Enhance Access to Places for PA Combined with Informational

Outreach

Strong evidence• Long-term efforts in worksites and/or communities to

improve PA opportunities• Environmental changes:

1.Create walking trails

2.Create exercise facilities

3.Better access to nearby facilities

*One of the top three recommended strategies

Kona, HI

ogging Path

Strategy 3: *Enhanced Physical Education in Schools

Strong evidence• Increase length of time that youth are active in PE

classes• Can be applied in various youth-oriented settings, such

as community recreation centers and after-school programs

*One of the top three recommended strategies

CATCH PE

• Increase MVPA to 40%• Teacher training and on-site TA• Policy – PE 90 minutes/3x wk• Curriculum – activity selection &

modification• Teaching and class management

strategies

Strategy 4: Point of Decision Prompts for Promoting PA

Strong evidence• Signage placed at the point where

decisions are made:1. Stairwells

2. Escalators

CDC’s StairWELL to Better Health

Strategy 5: Social Support Interventions in Community

Settings

Strong evidence• Build, strengthen and maintain social networks• Buddy systems• Walking clubs• Contracts

Strategy 6: Individually Adapted Health Behavior Change

Strong evidence• Tailored based on readiness for change• Target daily routines• Build social support• Prevent relapse into inactivity

Personal Empowerment Plan

• 12 week self-directed worksite program

• Targets stages of change

• Coordinator kit & promo materials

• Worksites can add activities

• revised/expanded

• Cooper Institute

Strategy 7: Street Scale Urban Design and Land Use to Promote

PA

Sufficient evidence• Local changes to support PA within a few blocks• Policies to improve lighting, traffic calming, etc.

Strategy 8: Community-Scale Urban Design, Land Use Policies &

Practices

Sufficient evidence• Target geographic areas to support PA• Policies and practices to develop/improve:

– Streets– Sidewalks and bike lanes

Community Design

Strategy 9: Active Transport to School

National Safe Routes to School Task Force found that SRTS interventions can be effective in increasing

physical activity and creating infrastructure to support physical activity.

• Supports youth in walking, bicycling, or skating to school• May involve urban design, land use policies, and

community• Includes neighborhood efforts (e.g. walking school bus)• 100’s of millions of dollars available!

CDC’sKidswalk-to-School

• Increase daily physical activity of children

• Improve pedestrian safety

• Educate and empower communities to create safe routes to school

Strategy 10: Transportation and Travel Policies and Practices

NICE (UK) review examined 26 studies and found that:

• Traffic calming• Introduction or expansion of multi-use trails• Closing or restricting use of road by motorized traffic• Road user charges• Improved cycling infrastructure• Safe routes to schoolResulted in increases in walking, cycling, and outdoor play

Intervention Characteristics

• Policy measures, e.g. roadway design standards

• Expanding public transportation services

• Subsidizing public transportation

• Providing bicycle lanes and racks

• Increasing the cost of parking

Key considerations for intervention selection

• Reach

• Acceptability

• Feasibility

• Sustainability

• Adaptability

Local adaptation

• Consider Social Ecological Model

• Realize that ALL interventions need some level of adaptation

• Seek out other forms of evidence (e.g., political will, stakeholder interests, evidence-based practice)

• Evaluate

Thank you

The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the

Centers for Disease Control and Prevention.