What Can We Do to Increase Physical Activity in Youth?
What Can We Do to Increase Physical Activity in Youth?
William H. Dietz MD, PhDConsultant, Institute of Medicine
Senior AdviserRobert Wood Johnson Foundation
Obesity Trends in Children < 5yo Pediatric Nutrition Surveillance System
Obesity Trends in Youth over the Past 12 Years
Ogden et al. 2012, NCHS data brief
Childhood Obesity: Signs of Progress
NYCNYC
Kearney, NEKearney, NE
Vance, NCVance, NC
Anchorage, AKAnchorage, AK
Fitchburg, MAFitchburg, MA
CaliforniaCalifornia
Chula Vista, CAChula Vista, CA
West West VirginiaVirginia
Philadelphia, PAPhiladelphia, PA
Somerville, MASomerville, MA
New New MexicoMexico
El Paso, TXEl Paso, TX MississippiMississippi
Energy Deficits Necessary to Achieve the HP 2010 (Prevalence = 5%) by 2020
Age Deficit2-5 yo 33 Kcal/d6-11 yo 149 Kcal/d12-19 yo 177 Kcal/d
Wang YC et al. Am J Prev Med 2012; 42:437
Effects of Physical Activity on Morbidity and Mortality across the Life Span
Physical Activity In Childhood
Physical Activity In Childhood
Physical Activity in Adolescence
Physical Activity in Adolescence
Physical Activity in Adulthood
Physical Activity in Adulthood
Morbidity in Childhood
Morbidity in Childhood
Morbidity in AdolescenceMorbidity in Adolescence
Morbidity in Adults
Morbidity in Adults
Mortality in Adults
Mortality in AdultsHallal et al. Sports Med 2006;36:1019
7
Physical Activity 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
http://www.health.gov/paguidelines
8
- Include muscle-strengthening activities at least 3 days a week
- Include bone-strengthening activities at least 3 days a week
• Physical activities should be age appropriate, enjoyable, and offer variety
http://www.health.gov/paguidelines
Key Guidelines – Children and Adolescents (ages 6-17) (cont.)
% High School Students Achieving 60’ MVPA - YRBS 2011
CDC. Youth Risk Behavior Surveillance. MMWR 2012; 61:1
Average Minutes/d of Accelerometer- Measured MVPA
Kohl HW III, Cook HC. Educating the Student Body, IOM 2013.
Opportunities for School-wide Physical Activity
Kohl HW III, Cook HC. Educating the Student Body, IOM 2013.
Decline in Active Transportation to and from School in 1969 and 2001; Nationwide Personal Transportation
Survey
Kohl HW III, Cook HC. Educating the Student Body, IOM 2013.
Opportunities for School-wide Physical Activity
Kohl HW III, Cook HC. Educating the Student Body, IOM 2013.
Frequency of School PE – SHPPS 2006
Daily PE PE 3d/w
Elementary 4% 14%
Middle 8% 15%
High School 2% 3%
Note: No school level data in 2012 SHPPS
Lee SM et al. J School Health 2007;77:435
Changes in Required or Recommended Recess 2006-2012
33%
38%
%
Lee SM et al. J School Health 2007;77:435; Lee SM et al. SHPPS 2012www.cdc.gov/healthyyouth/SHPPS/2012
Percent of Schools that Do Not Provide Recess to First Grade Students
Kohl HW III, Cook HC. Educating the Student Body, IOM 2013.
Changes in Activity Breaks SHPPS 2006-2012
Lee SM et al. J School Health 2007;77:435; Lee SM et al. SHPPS 2012www.cdc.gov/healthyyouth/SHPPS/2012
% of Schools
Energy Costs of Opportunities for PA in Schools
11
17
27
33
37
Bassett DR et al. PCFSN Research Digest March 2013; Series 14 #1
Evidence of Effectiveness of School Programs for PA
School-based PA interventions•Increases duration of PA for 5 - 45’/day•Decreases TV time from 5 – 60’/day
•Increases VO2 max
•Participants 3 times more likely to engage in MVPA
Dobbins M et al. School-based PA programs for promoting PA and fitness in children and adolescents aged 6-18. Cochrane Rev 2013
Opportunities for School-wide Physical Activity
Kohl HW III, Cook HC. Educating the Student Body, IOM 2013.
Percent of Boys and Girls Participating in Sports 1971-2011
Kohl HW III, Cook HC. Educating the Student Body, IOM 2013.
Participation in Interscholastic Sports by Boys and Girls by Availability of Sports Facilities 2009-2011
Colabianchi N. Bridging the Gap in Kohl HW III, Cook HC. Educating the Student Body, IOM 2013.
Healthy Kids Out of School: Drink Right, Snack Smart, Move More
Strategies to Increase Physical Activity in Youth
• Implement the Physical Activity Guidelines Midcourse Report
• Mobilize parents• Convene all relevant groups to develop and
implement a strategic plan• Improve the research base that links PA to
behavior and academic performance• Use QRIS, state, and local policies to
implement PA standards in ECE• Engage health providers at all levels in
Exercise is Medicine
Strategies to Increase Physical Activity Among Youth – PAG Midcourse Report
Sufficient evidence •Multi-component PA in schools•Physical education programSuggestive evidence •Active transportation•Early Care and Education•Built environmentEmerging evidence•Activity breaks
Strategies to Increase Physical Activity in Youth
• Implement the Physical Activity Guidelines Midcourse Report
• Mobilize parents• Convene all relevant groups to develop and
implement a strategic plan• Improve the research base that links PA to
behavior and academic performance• Use QRIS, state, and local policies to
implement PA standards in ECE• Engage health providers at all levels in
Exercise is Medicine
Parental Support for Physical Education
• A majority believe that PE is as important as other subjects (CDC 2010)
• Over 90% believe there should be more PE in schools (HSPH 2003)
• Over 75% think more PE could help prevent or control childhood obesity (NASPE 2009)
• 95% believe that daily PA helps children do better academically and should be part of K-12 curriculum (NASPE 2003)
National Physical Activity Plan – Strategy 2Tactics
• Binding requirements for Pre K-12 standards-based PE that address curriculum time, class size and employment of certified PE teachers
• Local, state and national standards for high levels of PA in PE
• Federal legislation to require school accountability for the quality and quantity of PE programs
National Physical Activity Plan – Strategy 2Tactics
• Local state and federal funding to assure that schools have the necessary resources, especially for under-resourced schools
• State-level policies to monitor quality and quantity of PA and PE programs
• Require school districts to collect, monitor and track fitness data including BMI
Strategies to Increase Physical Activity in Youth
• Implement the Physical Activity Guidelines Midcourse Report
• Mobilize parents• Convene all relevant groups to develop and
implement a strategic plan• Improve the research base that links PA to
behavior and academic performance• Use QRIS, state, and local policies to
implement PA standards in ECE• Engage health providers at all levels in
Exercise is Medicine
Children in Early Care and Education Programs
In 2001, 73% of preschool children ages 3-5 years old (8.6 In 2001, 73% of preschool children ages 3-5 years old (8.6 million children) participated in at least one weekly million children) participated in at least one weekly non-parental care arrangementnon-parental care arrangement
Nearly 60% of children 3-4 years with employed mothers Nearly 60% of children 3-4 years with employed mothers participate in center-based careparticipate in center-based care
41% of preschool children are in child care for 35 or more 41% of preschool children are in child care for 35 or more hours/weekhours/week
Capizzano J et al. www.urban .org/url.cfm?ID=309438; www.urban .org/url.cfm?Capizzano J et al. www.urban .org/url.cfm?ID=309438; www.urban .org/url.cfm?ID=309439ID=309439
Strategies to Increase Physical Activity in Early Care and Education
• Provide portable play equipment on playgrounds and play spaces
• Train staff in delivery of structured PA and increase PA session time
• Integrate PA into teaching and learning activities
• Increase outdoor time
Physical Activity Guidelines Midcourse Report. www.health.gov/guidelines
Strategies to Increase Physical Activity in Youth
• Implement the Physical Activity Guidelines Midcourse Report
• Mobilize parents• Convene all relevant groups to develop and
implement a strategic plan• Improve the research base that links PA to
behavior and academic performance• Use QRIS, state, and local policies to
implement PA standards in ECE• Engage health providers at all levels in
Exercise is Medicine
PA Counseling by Pediatricians
• Over 60% of pediatricians and family practitioners ask specific questions about the dose of PA1
• Overweight and obese patients more likely to receive PA counseling2
• Physician’s BMI predicts likelihood of counseling3
1. Huang T, et al. Am J Prev Med 2011;41:24-32
2. Liang L, et al. Pediatrics 2012;130:67
3. Bleich SN et al. Obesity 2012;20:999
Five Conditions for Collective Success
Common agenda
Shared measurement systems
Mutually reinforcing activities
Continuous communication
Backbone support for ongoing actions
Kania J and Kramer M. Collective impact. Stanford Social Innovation Review 2100 (winter); 59
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