Active by Default:

Getting Communities Moving 10 Minutes at a Time

Toni (Antronette K) Yancey, MD, MPH Professor, Department of Health Services

Co-Director, UCLA KP Center for Health Equity

The Problem

Extremely Low US Physical

Activity Levels*

Mean moderate to vigorous intensity PA

levels: US adults = 6-10 min/day

PA Levels meeting federal recommendations:

<5% adults

<10% teens

<50% children

*when objectively measured—NHANES (Troiano et al., 2008)

Leisure Time Physical Activity Levels:

Little Change in >2 Decades

Effects of Prolonged Sitting

• Increase in sedentary work, entertainment

& transportation means 95% of Americans

don’t get enough physical activity

• Sitting increases risk of death up to 40% &

doubles the risk of cardiovascular disease:

– Shuts off electrical activity in leg muscles

– Drops rates of calorie burning to 1/minute

– Drops fat-burning enzymes by 90%

– Drops good cholesterol & insulin effectiveness

A potential solution

“Push‖ vs. ―Pull” Pull strategies: Majority of physical activity promotion efforts,

including traditional worksite prog. rely on individual motivation--largely unsuccessful at population level

--Improvements greater in individual inclined to be active

Examples: gym membership subsidies, stair prompt posters, lunchtime or after-work exercise classes

Push strategies: Efforts to make the active choice the default option—the path of least resistance, requiring individuals to ―go out of their way‖ to make inactive choice

--Promise of broader engagement, including those at greater risk for obesity—including ethnic minority groups

Examples: walking meetings, exercise breaks during non-discretionary time at work, nearby parking restricted to disabled, scheduling meetings at a distance from workspace

Why worksites? The practical reasons… • Proportion of time spent at work is high & expanding

– Large proportion of daily caloric intake consumed during work hours

– Opportunities for physical activity outside of work hours may be limited

• Humans evolutionarily programmed for sedentariness & most won’t exercise on their own even if given instruction, encouragement and time, e.g., data entry workers reported stretching during only 25% of conventional breaks and 39% of supplementary breaks (Galinsky et al., 2007)

• Especially true for ethnic minority/low income populations who may work longer hours or multiple jobs, have longer commutes, and be single parents

Cross-sectional Workplace Studies

Employee Health Care Cost Savings

from Physical Activity

Among 23,490 employees at large corporation:

• Moderately active and very active employees had $250 less paid health care costs annually than sedentary employees across all weight statuses

• Savings were $450 for moderately and very active obese employees compared with their sedentary obese counterparts

Why worksites?

On the philosophical side…

• Changes made at work may spill over to home & school

• Growing realization of need for interventions to change the

physical & socio-cultural environment—work is important

context for such influence

• Recognition of cultural assets available to build upon, e.g.,

centrality of dance and music in ethnic minority populations

• Physical activity interventions focused solely on ―leisure-

time‖ behaviors less successful among lower income

individuals and people of color, especially women, those

with highest rates of chronic disease &obesity

• Need more interventions that ―push‖ vs. ―pull‖ someone to

choose active alternatives (i.e. make the active choice the

default choice that must be opted out of vs. opted in to)

Benefits of activity breaks • A simple 10% decrease in inactivity could decrease

healthcare spending by $150M/year

• Introducing 10-minute activity bouts in the workplace can:

Waist line, blood pressure, weight, and percent body fat

Appetite (relative appetite suppressant)

Urge to smoke

Stress and anxiety

Harmful effects of prolonged sitting

Speed and accuracy of data-entry

Engagement of inactive individuals

Mood, self-efficacy; self-esteem

Fruit and vegetable intake, water consumption

Overall (total) physical activity (due to spill-over to non-work settings)

Supportive work environment

Energy levels

Cognitive processing, especially executive function component (judgment, processing efficiency)

Bone density 11 11 11

Creating an Active School Day: Making activity the default option

Improving the quality of physical education (PE) and ensuring adherence to mandates for PE duration (200 min/10 d elementary/400 min/10 d secondary)

Integrating 10-minute Instant Recess break at scheduled time(s) of the day

Improving equipment & supervision to increase PA during recess

Establishing auto-free zones, e.g., bus drop-off point so that students & staff must walk 5-10 min.

Redesigning classrooms to substitute stability balls for chairs, rotations among small group activity stations

What Is Instant Recess®?

• Incorporation of 10-minute activity breaks into daily routine, e.g., on paid time or during non-PE classes

• Simple and easily replicable, low-impact, moderate intensity movements set to music and scientifically designed to produce a manageable level of exertion, positive and reinforcing affective responses and fitness improvements, and minimal injury risk for sedentary or overweight workers

• Structured to maximize accessibility & effectiveness while minimizing wasted time

• Implemented in over 1000 workplaces and thousands of schools since 1999, materials purchased in 45 states and DC, as well as 10 foreign countries

• Evaluated in foundation- & federally-funded studies

Short bouts easier for sedentary individuals, minimizing perspiration & hair/make-up disturbance

Variable intensity, low-impact physical activity accommodates higher proportion overweight, unfit and/or disabled individuals

Social support & desire for conformity drives participation

Activity breaks may be framed as fun, play, stress release, entitlement to move vs. exercise=work, drudgery, obligation to most people

Needed to counter negative activity framing typical in food policy debate

Integrating 10-Minute Instant Recess® Breaks into Organizational Routine

Activity Breaks Work! The rapidly growing evidence base

• Documented individual and organizational receptivity to integrating activity into routine ―conduct of business‖

• Contribute to daily accumulation of activity

• Motivational “teachable moment” helping inactive people link sedentariness to health status

• As little as 10 min./day improves BP, weight, waist circumference, mood, attention span, cumulative trauma, absenteeism, employee retention, bone mineral density, academic performance, discipline

• “Spill-over” to increases in active leisure

• Favorable return on investment — LL Bean mfg. plant gets 30 min. productivity for 15-min. investment (three 5-min. breaks per shift)

Studies

• 10-min. Instant Recess® during staff / training meetings longer than 1 hour

• 449 employees, mostly overweight, middle-aged women, ethnically diverse

• 90+% participation

• Demonstrated feasibility of engagement regardless of weight or physical activity levels

• Found group breaks add social conformity factor that positively influenced participation

• ―Teachable moment‖ - increased individual awareness of poor physical conditioning and health status

California Fit WIC

Staff Wellness Training

Significant findings:

• Increased perceived workplace support

for staff PA (96 vs. 58%, p=0.002)

and healthy food choices

(85 vs. 28%, p=0.001)

• Change in types of foods served during meetings (72 vs. 24%, p=0.002) & PA priority in workplace (96 vs. 71%, p<0.02)

• Increased self-reported counseling behaviors with WIC parents promoting physical activity (64 vs. 35%, p<.05) & sensitivity in handling weight-related issues (92 vs. 58%, p<0.01)

Pilot Study Baseline Data:

Worksite policies/practices PA Promotion Policy/Practice Endorsed n %

Casual attire during working hrs 15 68%

Standing/stretching/fidgeting during meetings 12 55%

PA on paid work time during wkday* 7 32%

Exercise breaks during meetings or time(s) of wkday 6 28%

Policy (formal or informal) supporting employee PA 6 28%

Flex time to accommodate PA 4 18%

Walking club(s) 4 18%

*Correlated with higher % employees reporting group PA during wk (t(274)=2.47, p=0.01

Pilot Study Outcomes

Baseline sample:

– N =391 across 25 sites, health and human services gov’t & non-profit wk units

– Predominantly female (89.77%) & African American or Latino (78.24%)

– Mean age = 43.5 yrs

– Mean BMI = 30.0 kg/m2

– Mean WC = 90.5 cm (35.6 in)

6-Month follow-up sample (Cohort 3 only):

• N = 130 individual participants (90% reten.)

• 8 work units: 6 Intervention, 2 Control

• Preliminary findings:

Intervention Control

BP (mm Hg) 1.3 1.2 (effect size = -2.5)

BMI (kg/m2) 0.01 0.4 (effect size = -0.4)

REACH Dissemination Mid-Point

Evaluation Outcomes

• 36 health & human services agency worksites in

LA and Orange Co, CA

• Significant increases in:

1. Exercise break policies (meetings &

scheduled time of workday)

2. Nutrient-rich food procurement policies

3. Policies requiring nutrient-rich

foods/beverages in company meetings

Maxwell et al., Prev Chr Dis, 2011

REACH Organizational Wellness

Assessment Outcomes

South Bay Health Center

• Launched Instant Recess® Jan 2011 in call

center, Apr in lab/path, Jun in in-pt unit 3000

• Compared to 2010 data from same period,

reduced sick days by 1.8 days/FTE (7.5 – 5.7) in

call center, 1.9 days in an in-pt unit (6.2-4.3)

• Injury rates--―accepted workers’ comp claims‖--

decreased from 3 to 0 (call center x 8 mos), 18

to 12 (lab x 4 mos), 1 to 0 (in-pt x 2 mos)

Instant Recess® @

Champion Schools, Phoenix

Pre-tested at the Champion charter school in a low-income

Phoenix, AZ area

Hosted ―Think You Got Moves?‖

contest winning Wave move

selected for San Diego Padres’

FriarFit IR DVD

Comments from teachers:

• ―feasible to use daily because helps kids settle down

after lunch‖

• ―kids, girls especially, perform better in PE class because

IR exercises build their confidence‖

• ―kids are taking ownership and bringing their own music‖

Instant Recess® @ Winston-

Salem/Forsyth County, NC USD

Evaluation of IR in implementation of policy

change to require 30 minutes of daily PA in

elementary school day: 8-school pilot study

• Increase in % of children doing fitness skills (IR)

Intervention (+9%) vs. Control (0%), p < 0.05

• Increase in % of children who were ―on-task‖

Intervention (+6%) vs. Control (-5%), p < 0.05

Just piloted district-wide in all 16 middle

schools with 12,000 students daily

Mean Minutes of Light, Mod. & Vig. PA in WSFCUSD Classes (SOFIT)

Instant Recess® @ LAUSD

• Active Living Research dissertation grant

• 6 schools, n=647 students with baseline + follow-up data, 68 participating teachers/classrooms

• Cluster RCT with early intervention-delayed intervention control groups--main outcome = school day pedometer readings (measured beginning & end of school day)

• Final model: Linear regression of post-treatment steps on both intervention groups and baseline steps, clustered by school, and student ID (R2 = 0.2292, F = 78.41 (p < .001))

• Results: Adjusting for intervention group, mean steps significantly increased with IR intervention (+1910.3 steps; p<.001)

Other Activity

Break Intervention

Studies:

Cases & Trials

Pausa para tu Salud

Mexican Ministry of Health

Mexico City

• 10-15 minute exercise breaks to

music broadcast thru intercom

system

• Mandatory

• Secondary analysis of data,

n=335, collected annually on all employees

• Not study volunteers—75% retention at 1 year)

• 1 kg weight loss (0.4 kg/m2) + 1.6 cm ―waist‖ loss after 1 year

Manufacturing Facility

• Has provided brief stretch breaks on company time since 1982

• Productivity measurements indicate 30 min. returned productivity for every 15 min. invested in exercise (5-min. breaks 3x/day)

• Reduced work-related injuries from 14/yr to essentially none within 1st 3 years

• Stretch breaks are viewed as a safety measure similar to wearing safety glasses

• Have now increased to a few minutes every hour!

Replacements, Ltd. Greensboro, NC

• Instituted 10-minute group stretch breaks on the clock

every morning & afternoon 5 yrs ago in 550-employee

distribution center

• Occupational RN identified two departments with large

numbers of musculoskeletal complaints. Provided

instruction sheet to Dept #1 for individual use at their

desks; in Dept#2, turned on music and employees did the

stretches as a group ―on the clock‖ scheduled into the

daily routine.

• Dept #2 saw greater impact on musculoskeletal

complaints due to higher participation rates

• Decreases in workers’ comp claims led to decrease in

premiums

Westinghouse Plant College Station, Texas

• Study participants were employees who assembled computer boards

• Performed set of 23 flexibility and strength exercises designed to prevent lower-back & carpal tunnel injury

• 10 minutes each day on company time under supervision.

• Daily participation rates 97-100%

• Significant improvements observed in wrist flexion, wrist extension, lower-back flexibility, fatigue, and mood, compared with a control group that did not participate in these exercises

Danish Public Administration

Authority

• 616 office workers from 9 sites in dif. geographic areas

• 3-group design, all allotted 1 hr/wk during paid time:

A Three 20-min. neck & shoulder resistance training exercises

B Varied physical activity (PA)--organized walks, 8-min. aerobic & resistance exercise CD, steppers at copiers, hallway punching bags

C Attention controls—group discussion of worksite wellness—no PA!

• Both PA conditions worked compared with controls:

✪Statistically significant systolic BP (-6 mm Hg), body fat (-2.2%), shoulder & back pain

✪Statistically significant muscle strength, VO2max (aerobic capacity)

University of Kansas PAAC

Cluster Randomized

Controlled Trial Outcomes

•Main effects on:

(1) accelerometry-monitored daily PA, in-school, and

outside school—both weekend, weekday

(2) improved academic achievement for reading,

math, spelling & compos. scores

•Disaggregated by exposure:

(1) 9 of 14 intervention schools averaged 75+ min.

active lessons/wk

(2) these schools showed signif. less increase in BMI

When teacher were active with students, student PA levels

were significantly higher!

Dissemination

Network for a Healthy CA CA Dept of Health Svcs./Public Health

Initial source of

support for LA Lift Off!

via USDA food stamp

nutrition education

funds in 2000

Funded development

of first Instant Recess®

break with Allen

Rossum & the Pro.

Athletes Council in

2007

WNBA LA Sparks’ SPARKing Motion Accomplishments

• Sample moves: *Thompson Tip-off *Milton-Jones Jumper *Parker Power Jam

• Launch event featured first-ever in-game exercise break in a professional sports contest and distribution of 1000 CDs + photo guide inserts

San Diego Padres’ PETCO Park on Sunday home game “family” days

Organizational Profiles – In Brief

• City of Duarte, CA – 3-min PA breaks every City Council

meeting x 6 yrs

• Delta Sigma Theta Sorority, LA – turns up AC 15 min

pre-IR break each mtg & reimburses members only for

healthy refreshments x 5 yrs

• Orange Co. Health Dept, CA – trained entire health

promotion staff in implementing & dissem. IR breaks x 3

yrs

• St. John’s CME Church, NC – occasional IR breaks

during Sunday service increased participation in gospel

aerobics classes

• WPFW Pacifica Radio Station, DC – broadcast 10-min IR

breaks daily x 6 mos; re-launching w/ Wobble Dance IR

Washington Post “Instant Recess…calling card for the National Physical Activity Plan

SHIRE non-profit, Washington, DC

Dr. Yancey goes to Washington!

Alliance for a Healthier Generation

• Healthy School Framework including 8 areas of focus • Activity breaks most commonly selected PA intervention along with elementary

school recess: 75% of those inventoried (sample n=3504) of 12,000+ participating schools endorsed item “All students have the opportunity to participate in physical activity breaks on a daily basis.”

• Success Stories: “Get up and moving each & every morning before flag salute” --John Glenn Elem., Pine Hill, NJ “Students are running or power walking 2/5 mi before they play at recess and

principals, teachers & other staff routinely move with them…students more energetic & attentive in PM classes, eating healthier foods & throwing less away at lunch, and exhibiting fewer behavior problems during recess

--Jackson Elem., St. Paul, MN “Use technology to get classes moving, uploading PA videos to school server

and streaming them 4x/day so teachers can use at their convenience --Norris Elem., Firth, NE

HEALCitiesCampaign.org CA League of Cities & CCPHA

22 cities have now

adopted policies

advocating activity

breaks in meetings

lasting an hour or longer

First 5 LA Commission informally

adopted & featured IR® break at Sep

2011 meeting, and now on Oct agenda

for formal policy change!

Amazon book ranking

Nov 21, 2010--318,000

Nov 23, 2010—21,000!

Sitting All Day: Worse For You Than You Might Think

by PATTI NEIGHMOND

April 25, 2011 ... breaks? Toni Yancey's Instant Recess book

offers the following suggestions for people who feel chained

to their office desks:

http://www.npr.org/2011/04/25/135575490/sitting-all-day-

worse-for-you-than-you-might-think

Amazon book ranking

April 24,2011--523,000 April 25,2100--2300!

Adopts Instant Recess® in support of Let’s Move!

Plymouth UCC

(North

Houston, TX)

―Musical Pews‖

IR break

The Jesus Shuffle

Washington Post September 6, 2011

IR on campus! Arizona State U.

IR at school!

CBS News, 9/22/11

Midlands, TX school district

adopts IR

Only Exposure

(of which we’re aware)

Prompting Adoption is

via YouTube

KEEN “Recess Is Back!”

Began as marketing

campaign

Now viewed as part of

company ―DNA‖

2020 goals for instigating

Recess Revolution

Recess breaks:

The smoking ban of the

physical activity movement?

Instant Recess® materials are available

• For purchase at: www.toniyancey.com/instantrecess

• For free streaming at: www.youtube.com/tonikyancey

www.youtube.com/gramercyNC

• For free download at: www.gramercyresearch.com

• Materials are available in audio (CD) and video (DVD) format

Selected References • Barr-Anderson D et al. Structural integration of brief bouts of physical activity into

organizational routine: systematic review. AJPM 2011;40:76-93.

• Crawford P et al., Walking the talk. AJPH, 2004;94:1480-1485.

• Donnelly J et al. Physical Activity Across the Curriculum: RCT to diminish overwt & prev. obesity in elem. school children. Prev Med 2009;49:336-41.

• Galinsky, T et al. Supplementary breaks and stretching exercises for data entry operators: a follow-up field study. Am J Indus Med 2007;50, 519-27.

• Lara, A, Yancey, AK, Tapia-Conyer, R et al. Pausa para tu Salud: reduction of weight and waistlines by integrating exercise breaks into workplace organizational routine. Prev Chronic Dis 2008;5:A12.

• Pronk, SJ, Pronk, NP, Sisco, A et al. Impact of a daily 10-minute strength and flexibility program in a manufacturing plant. Am J Health Promot 1995;9:175-8.

• Wang F, McDonald T, Champagne LJ, Edington DW. Relationship of BMI and physical activity to health care costs among employees. J Occup Environ Med 2004;46:428-436.

• Woods D. Implementation of 10-minute exercise breaks in LAUSD elementary schools. UCLA School of Public Health. Filed May 25,2011.

• Yancey A. “Pushing Workplace Physical Activity. NHLBI Chronic Disease Prev. in the Workplace Expert Convening. Washington, DC. May 21, 2009.

• Yancey T (AK). Getting our instant gratification society moving, one school at a time. CAHPERD Journal 2011;73(1):34-39.

• Yancey T. Instant Recess: Building a Fit Nation 10 Minutes at a Time. Berkeley, CA: University of California Press, 2010.

Instant Recess® team

Senior Investigators: McCarthy, Bastani, Berrien, Cole,

Eisenberg, Fielding, Gonzalez, Guinyard, Kumanyika,

Maxwell, Perot, Sallis, Simon, Taylor

Junior Investigators: Whitt-Glover, Glenn, Keith, Alhassan

Post-docs: Bell-Lewis, Hasson

Students: Hopkins, AuYoung, Jackson, Leak, Woods

Administrators/Business Leaders: Wilson, Anderson,

Bernert, Eisenberg, Flores, Girard, Graham, Harding, Keith,

Kimbrough, Levine, Miles, Nevarez, Osby, Overton, Pittman,

Ross, Sanchez, Standish

Pro Athletes/Talent: Rossum/PAC, Winfield, Jones, Milton

Facebook.com/InstantRecess @InstantRecess