2009 Consensus Conference - CSEP · 2009 Consensus Conference – Advancing the Future of Physical...

This conference brought together international experts to listen to the evidence compiled, to

debate, discuss, and reach consensus on what the evidence indicates in terms of physical

activity guidelines; what is the strength of the evidence; what gaps should be addressed and

in what order; how this initiative could be aligned with other international efforts; whether the

existing guidelines should be modified; and whether the existing suite of Canada’s Physical

Activity Guides should be modified.

Hosted by the Canadian Society for Exercise Physiology

Supported by the Public Health Agency of Canada

2009 Consensus ConferenceAdvancing the Future of Physical Activity

Measurement and GuidelinesJanuary 14-16, 2009

Delta Lodge at Kananaskis, Kananaskis, Alberta

2009 Consensus Conference – Advancing the Future of Physical Activity Measurement and Guidelines Canadian Society for Exercise Physiology 2

CONFERENCE SUMMARY The presentations on Wednesday and Thursday focussed on four of the five systematic reviews commissioned by the Canadian Society for Exercise Physiology (CSEP) to examine the current scientific evidence underlying physical activity recommendations. The presentations were targeted to an independent five-member panel of experts whose responsibility it was to listen to the evidence, assess the quality of the evidence and the strength of the recommendations. On Thursday, additional presentations were made on Mental Health and the role of Sedentary Behaviour within in a physical activity framework, followed by four presentations on similar concurrent international initiatives to develop physical activity guidelines in other jurisdictions. A select group of international experts from the physical activity sciences and health promotion mileu were invited to comment on the presentations and ask questions.

Wednesday, January 14 Project History and Overview and Consensus Conference Objectives Dr. Mark Tremblay, Director, Healthy Active Living and Obesity Research, CHEO, Ottawa Dr. Tremblay provided an overview of the Physical Activity Measurement and Guidelines (PAMG) project, commencing with the Think Tank conference held in Halifax in November 2006. This event confirmed the need to re-examine and update the evidence underlying Canada’s physical activity guidelines for adults, older adults, and children and youth which were published in 1998, 1999 and 2002 respectively. During 2007, the CSEP commissioned 12 reviews concerning the current guidelines, gap areas and associated topics and published these papers, along with an introduction and conclusion, in a special joint issue of the Canadian Journal of Public Health/Applied Physiology, Nutrition and Metabolism in November 2007. At around this time, the CSEP was approached by the Canadian Vascular Coalition to explore the development of clinical practice guidelines using physical activity as a chronic disease prevention measure. Clinical practice guidelines are normally developed through a rigorous process of a systematic review of evidence, followed by a quality assessment and grading of the evidence. Five systematic reviews were commissioned in 2008 on physical activity guidelines for youth and children, adults, older adults, mediators of physical activity behaviour change, and physical activity messaging. The CSEP is using the internationally-recognized Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument to assess the evidence and quality of the guidelines development process (physical activity recommendations). Authors were to assign a level of evidence using a 1-4 scale and a grade to the evidence using an A-B-C scale consistent with the GRADE protocol and harmonized with the procedures used in the development of the Canadian Clinical Practice Guidelines for the Prevention and Treatment of Obesity in Children and Adults. This conference is the stage in the AGREE process where the results of the systematic reviews were presented. An arms-length Expert Panel of five experts in the area of medicine/physical activity and/or public health (biographies appended) was in attendance to listen to the evidence and prepare a Consensus Statement outlining their recommendations based on the evidence presented and discussed. These members were: Antero Kesaniemi (Chair) – Finland, Bruce Reeder – Canada, Thorkild Sorensen – Denmark, Chris Riddoch – United Kingdom, Steve Blair – United States, with support from Ashlee McGuire – Assistant to the Expert Panel.


The Expert Panel Roles and Responsibilities were to: • Read background documents and Systematic Reviews • Participate in pre-conference meetings • Attend and participate in the conference • Listen to presentations and discussions • Ask questions and seek clarity as required • Work as a group to achieve consensus on recommended physical activity guidelines for

Canadians based on evidence presented • Agree on level of evidence informing physical activity guidelines • Prepare consensus statement for publication

The overall objectives of the conference were to:

• Share information on the Canadian PAMG Project • Provide a collegial forum where consolidated research literature relating to physical activity

guidelines for asymptomatic populations can be presented, discussed, debated and clarified • Challenge preconceived notions of physical activity guidelines and debate the relative

importance of reducing sedentary behaviour • Discuss physical activity guidelines “gap” areas and establish priority areas for future work

(preschool, teens, disabled, Aboriginal, pregnancy) • Discuss messaging and dissemination strategies for physical activity guidelines (e.g. Canada’s

Physical Activity Guides) • Compare initiatives, strategies and guidelines from other countries • Discuss opportunities for international harmonization, coordination and cooperation to reduce

duplication, ensure consistent interpretation of the literature and minimize confusion • Create an opportunity for an appropriate, unbiased, independent assessment of the evidence

presented • Embed mechanisms to allow for the documentation and rigorous assessment of the physical

activity guidelines development process Children and Youth Physical Activity Guidelines Systematic Review Dr. Ian Janssen, School of Kinesiology and Health Studies, Queen’s University, Kingston

Dr. Janssen’s presentation outlined the process he followed to examine the literature related to the evidence for physical activity guidelines for children and youth 5-19 years old. The results of the 5-14 year-old age group were presented, with a separate presentation for older adolescents (15-19) scheduled for January 16. Dr. Janssen presented the current physical activity guidelines for children and youth (5-14 years old):

1. Increase daily physical activity by 30 minutes, and progress to 90 minutes more. 2. The increase should include 60 minutes of moderate activity and 30 minutes of vigorous activity. 3. Physical activity can be accumulated in periods of 5-10 minutes 4. Combine endurance, flexibility, and strength activities No guidelines for preschool children or older adolescents.

Questions that were addressed in his systematic review included: How much physical activity is needed for minimal and optimal health benefits? What types of activity are needed?


Does intensity matter? Do the effects vary by sex or age?

The overall systematic review methodology eligibility criteria was limited to seven health measures: (i) High cholesterol, (ii) High blood pressure, (iii) Metabolic syndrome, (iv) Overweight/obesity, (v) Low bone density, (vi) Depression, and (vii) Injuries. Both observational and experimental studies were reviewed. Eligibility criteria for observational studies were: health outcome(s) must have been measured in a dichotomous manner and presented as a ratio score or prevalence. This decision was made to: (1) Ensure consistency in measures of effect; (2) Keep the review manageable in size; and (3) Help limit to studies with larger sample sizes. Eligibility criteria for experimental studies were: Any form of physical activity based intervention was eligible. Studies were excluded if the intervention targeted other behaviours (e.g., diet) in addition to physical activity. Dr. Janssen reported that literature searches were conducted in 6 search engines (MEDLINE, EMBASE, CINAHL, PsycINFO, Evidence-Based Medicine Reviews, and SPORTDiscus) in January 2008 using pre-defined search terms, there was no exclusion on year of publication, publication type, or study design, and the search was limited to Human subjects and English language. The search yielded 13174 papers (11088 after duplicates eliminated) and 454 papers were retrieved for a full-text review and 86 eligible citations representing 119 outcomes were selected for the review. Dr. Janssen presented the results for each of the seven variables. A consistent theme with each outcome was that physical activity did have an impact on these health variables but for the most part the dose-response relations were not systematically studied and remain unclear. Dr. Janssen also presented the limitations to the quality of the studies reviewed and noted that these may have impacted on the dose-response results. He recommended that these factors should be considered when designing future research studies. Experimental: Consistency of several severe limitations: • small, non-representative samples. • lack of statistical power • no reporting of adverse events • lack of details on drop-outs • no intent-to-treat analysis • lack of blinding for interventions and evaluations

Observational: • Majority employed cross-sectional

designs • Most relied on self-reported measures of

activity • Samples were not representative in most

studies • Many were underpowered

Dr. Janssen’s specific recommendations will be outlined within the final peer-reviewed paper to be submitted for publication during 2009.


A Systematic Review of the Evidence for Canada’s Physical Activity Guidelines for Adults Dr. Darren Warburton, School of Human Kinetics, University of British Columbia, Vancouver

Dr. Warburton’s presentation detailed the process to conduct the systematic review of evidence for physical activity guidelines for adults 20-55 years old. He presented the current guideline:

Canada’s physical activity guidelines for adults recommends that 20-55 yr old adults accumulate 60 min of daily physical activity or 30 min of moderate or vigorous exercise 4 days a week: “Scientists say accumulate 60 minutes of physical activity every day to stay healthy

or improve your health. As you progress to moderate activities you can cut down to 30 minutes, 4 days a week. Add-up your activities in periods of at least 10 minutes each. Start slowly… and build up.”

Dr. Warburton reported that his review was to examine the evidence for a dose-response relationship between: (1) Physical activity and all-cause mortality, and (2) Physical activity and the incidence of the following chronic conditions (cardiovascular disease (except stroke)), stroke, hypertension, colon cancer, breast cancer, type 2 diabetes, and osteoporosis. He noted that the seven chronic conditions were identified a priori as diseases with the strongest supporting literature (Katzmarzyk and Janssen, CJAP 2004). The search parameters used included:

• Systematic and evidence-based approach. • Studies that evaluated the relationship between at least three different levels of physical

activity and mortality or incidence of the 7 chronic diseases were eligible for inclusion. • Any form of physical activity/fitness measurement (e.g. self-report, pedometer, accelerometer,

maximal aerobic power (VO2max)) was eligible for inclusion. • The key outcomes were mortality and incidence of chronic disease. • Healthy (asymptomatic) adults (19-65 yr) were included. • Six major databases were searched using a pre-determined list of search terms: –MEDLINE

(1950–March 2008, OVID Interface); EMBASE (1980– March 2008, OVID Interface); CINAHL (1982– March 2008, OVID Interface); PsycINFO (1840– March 2008, Scholars Portal Interface); Cochrane Library (-March 2008); and SPORTDiscus (1830-March 2008).

Dr. Warburton reported that the initial searches yielded 20,265 citations that met initial criteria and warranted further evaluation; of these, 247 were selected for inclusion in the review. Of note is that the aggregate for most chronic conditions involved over 500,000 subjects each and the follow up for the prospective cohort studies ranged from 8.7 to 14.6 years. The main findings confirmed that moderate to vigorous physical activity, consistent with current guidelines, attenuated the risk for each health outcome by 20-35%. Dr. Warburton also demonstrated an inverse dose-response relationship exists for many of the conditions assessed, the exception being osteoporosis (although there is compelling indirect evidence to support a relationship). Dr. Wartburton’s specific recommendations will be outlined within the final peer-reviewed paper to be submitted for publication during 2009. He also posed questions for future research:


• It is unclear whether a volume of exercise lower than that currently recommended is associated with a lower risk for varied chronic conditions, or helps in initiating a more active lifestyle. As such there is no certainty regarding the minimal volume of activity.

• Additional research is required to examine the relationship between physical activity in specific sub-populations (including various racial and ethnic groups, and those of low socio-economic status).

Thursday, January 15 Physical Activity and Functional Limitations in Older Adults Dr. Don Paterson, School of Kinesiology, University of Western Ontario, London

Dr. Paterson emphasized that the outcome considerations were very different for older adults in comparison to the younger age groups. In particular, the following principles should be kept in mind:

• The importance of functional capacity, functional independence as an outcome (“performance” related fitness)

• It is important to analyze “short-term outcomes” of “exercise training programs” - more immediate effects of increased CR fitness, strength (and

function) within a few weeks to months; (in contrast to life-long physical activity effects – epidemiology) “never too late to start”; (not just “long-term” physical activity)

• The need to Interpret “absolute” intensity (as used in epidemiological studies; moderate and vigorous defined by METs) to a “relative” intensity which older person rates as moderate, or vigorous (and good physiological evidence that relative as %VO2max, or % critical power, or relationship with estimated lactate threshold applies similarly in older adults)

As a result, Dr Paterson noted that in considering evidence associated with the benefits of physical activity applicable to population groups, and in particular to older adults, the following classes emerge: (i) physical activity and all-cause mortality and morbidity (covered in the adult review and the 2007 CJPH/APNM paper); (ii) physical activity and fitness, performance (not applicable), and (iii) physical activity and functional independence, disability. Therefore he focused the systematic review on the relationship of physical activity with functional outcomes – to prevent limitations, disability, cognitive losses and exercise training program influence on functional outcomes (not just physiological and performance impairments). Dr. Paterson reported that the database searches, using pre-defined search terms related to physical activity and functional outcomes yielded 2080 unique citations, 345 were selected for detailed assessment and 85 were included in the review. The review of physical activity and cognitive function returned 824 unique citations, 77 were selected for detailed analysis and 32 were included in the review. Several studies known by the investigators related to each area will be added to the next draft. Results 1. Regular (aerobic) physical activity confers a reduced risk (~ 30-50%) of functional limitations

and disability in older age 2. Chronic Exercisers, joggers in middle-age and continued – postponed disability and functional

limitations, and prolonged disability-free life (compression of morbidity) 3. Strength: greater strength (handgrip) relationship with decrease in functional limitations and

ADL disability; relationship but not the evidence that strength-related activities are associated


with reduced risk of limitations 4. Persons with clinical conditions, functional limitations, disability, frailty, >85 years: were not

the subject of this review; however, there is evidence that a physical activity or exercise program can improve some functional abilities but little support for delaying progressive loss and disability, and that strength and balance exercises may be recommended.

5. Prospective studies suggest long-term lifestyle of physical activity, whereas these interventions add that a short-term physical activity intervention (combined aerobic and muscle power) is also effective

6. Prospective studies provided evidence that habitual physical activity reduces subsequent risk for dementia and Alzheimer’s disease

7. Exercise training studies showed a positive effect on at least one cognitive function measure Dr. Paterson’s specific recommendations will be outlined within the final peer-reviewed paper to be submitted for publication during 2009. He left the audience with an intriguing physical activity tagline recommending that older adults need to: “Get Fit for Active Living”. Mental Health: The Evidence Dr. Rod Dishman, University of Georgia, Athens

Dr. Dishman presented the results of the evidence-informed review that he chaired for the US Physical Activity Guidelines Advisory Committee in 2008. Given that this area had been recently, and thoroughly reviewed by one of the foremost experts in the field, it was considered an unnecessary duplication to repeat the same review in Canada as part of the Canadian PAMG project. The questions that Dr. Dishman’s group asked were as follows:

1. Does physical activity protect against the onset of disorders or symptoms?

2. Does physical activity reduce symptoms? 3. Do the effects of physical activity on symptoms differ according to age, gender, race/ethnicity,

or medical condition? 4. Do the effects of physical activity vary according to features of physical activity including type,

intensity, or timing (i.e., session duration, weekly frequency, and length of participation). Topics Reviewed: Areas: depression, anxiety, distress/wellbeing, cognitive function and dementia, sleep, self-esteem, chronic fatigue Summary of the Evidence: • The evidence from prospective, observational studies and RCTs indicates that moderate to vigorous

physical activity is associated with: o fewer symptoms and incident cases of major depression o fewer symptoms of anxiety and distress o reduced onset of cognitive decline and odds of dementia o enhanced: feelings of well-being; cognitive function; sleep quality; feelings of energy; self-


esteem • Outcomes are generally positive for men and women of differing ages, nationalities, and health

status; however, there are few direct comparisons according to ethnic or minority groups • Evidence from both observational and randomized controlled studies suggests a dose-gradient for

depression symptoms that occurs within current public health recommendations for moderate-to-vigorous physical activity.

• Insufficient evidence to determine whether an increase in fitness is necessary for mental health benefits; positive relations seen for depression and self-esteem may be a surrogate index of intervention adherence

Overall Conclusion: The scientific evidence from prospective cohort studies and randomized controlled trials supports the overall conclusion that regular participation in moderate-to vigorous physical activity is associated with improved aspects of mental well-being and reduced symptoms of several mental health problems and CNS disorders. Dr. Dishman concluded is presentation with a recommendation that future research in the area of physical activity and mental health should focus on:

• More prospective cohort studies and tightly controlled RCTs, especially for anxiety and sleep disorders.

– More studies of under represented groups – More studies of people at high risk of mental health disorders – Selection of potential confounders specific to mental health – Better reporting of adherence/dropout in RCTs: its impact on efficacy – Convergence of subjective and objective measures of physical activity and its context.

• Selection, refinement, and uniform use of valid outcome measures – More frequent measurement of exposures and outcomes to permit modeling of

change – More RCTs comparing the effects of exercise with other preventive interventions – Novel designs that distinguish social moderators and mediators of outcomes from

experimental contamination (i.e., placebo effects) • Studies that manipulate or directly compare standardized features of physical activity

(including type, intensity, and timing) and its setting (e.g., group vs. solitary; community vs. home; indoor vs. outdoor).

• Accelerated synergy between human brain imaging studies and neuroscience studies using animal models of human disease to elucidate biological mechanisms. (More modeling of social-cognitive mediators of mental health outcome; studies of gene-environment interaction)


Mediators of Physical Activity Behaviour Change among Adult Non-Clinical Populations: A Systematic Review Update Dr. Ryan Rhodes, University of Victoria, Victoria

Mediators have recently come under scrutiny as a differentiating factor in the success or failure of an intervention to change behaviour associated with physical activity participation. Dr. Rhodes noted that this was a relatively new area of research i.e., most advances have occurred within the past ten years, and that that there are overall relatively few studies to test these theories that have been undertaken to date. Purpose of the Review • Update the literature on behavioural

mediators of physical activity interventions since the time of these prior reviews (Baranowski et al.,1998, Lewis et al., 2002)

• Include all resulting theories/mediators applied to Physical Activity in interventions • Focus on physical activity as a form of primary prevention among adults (non-clinical populations) Study Eligibility Criteria • Published journal articles describing an experimental or quasi-experimental trial examining the

effect of the theoretical intervention on physical activity behaviour change and on proposed mediating variables e.g., self-regulatory actions such as planning, using reinforcements, self efficacy

• Excluded studies were those that: o Examined adherence to physical activity behaviour or stage of change only o Did not measure a change in mediating variables o Described only the process of the study without stating results o Used non experimental or quasi-experimental designs o Were written in any language other than English

Four major databases (ISI Web of Knowledge, SPORTDiscus, psycINFO and MEDLINE) were searched using a pre-determined set of search criteria, looking at a publication timeframe of 1998-2008. 6620 citations were identified and after screening for duplicates and applying exclusion criteria 27 unique trials were identified. Studies were grouped in total and by theory: Social Cognitive Theory; Transtheoretical Model; Theory of Planned Behaviour; Protection motivation theory; and Self-Determination Theory. A more specific grouping was also conducted at the construct level (Bandura, 1998; Fishbein et al., 2001): self-efficacy/control (i.e., self-efficacy, perceived behavioural control); outcome expectations (outcome expectations, attitude/behavioural beliefs, pros, cons, response efficacy, vulnerability, severity); self-regulatory processes or goals (intention, planning, goals, self-regulation, behavioural processes); social expectancies (social support, subjective norm). Studies were coded for:

• SYMMETRY between the behaviour and mediator • showing ASYMMETRY • Symmetry was further subcoded:

o as positive (i.e., behaviour change and mediator change) o negative (i.e., behaviour and mediator did not change)

• Asymmetrical results were further subcoded: o behaviour changed but not the mediator o the mediator changed but not behaviour.

Results:


• 21/26 showed some symmetry between the proposed mediator constructs and behaviour • 9/21 showed positive symmetry, however

o Not distinguishable from methodological characteristics of the negative symmetry findings or asymmetrical results

• 4/6 studies with formal mediation showed support for mediation • Of 27 samples since Lewis et al. (2002), 26 were deemed moderate or high quality • Almost all failed to include a direct physical activity measure and to pilot test the intervention

with the mediators • 81% of studies showed evidence for symmetry of mediator and behaviour results

o Formal mediation tests in half the cases where appropriate o Unfortunately, most evidence is negative symmetry o Inability of the intervention to affect the mediator or behaviour (over 50% of cases)

• Does not challenge our current theories • Literature too limited to draw conclusions among theories • At the Construct level – Mixed Evidence

o Self-regulation constructs showed the most evidence of symmetry and some evidence in formal mediation (Lewis et al., 2002)

Self-efficacy outcome expectations (affective vs. instrumental) social constructs (social support vs. subjective norm)

Dr. Rhodes concluded his presentation with the following recommendations for further research: • Innovation and higher fidelity interventions (environmental, experiential, social shifts) • Exploration of additional modifiable variables?

Integration of Sedentary Behaviour Guidelines Dr. Mark Tremblay, Director, Healthy Active Living and Obesity Research, CHEO, Ottawa Dr. Tremblay presented a thought-provoking series of questions around the increasingly important issue of sedentary behaviour habits and their relationship to physical activity guidelines, public health and physical activity promotion. What has changed?

• Has emphasis on sport declined? • Have organized activity opportunities decreased? • Has the built environment changed? • Has screen time availability and use increased? • Has incidental movement or Non-exercise Activity Thermogenesis (NEAT) decreased? • Have our microenvironments changed? • Why do we place so much attention on leisure-time physical activity (LTPA) (self-reported no

less!)? • Are we focusing on the right things? Or at least everything we should be focusing on? • Recommendations cluster around 30 min moderate-to-vigourous physical activity (MVPA) daily • Surely the other 23.5 hours (98%) of the day matter – do we remain silent on this? • Why focus on the 2% and not the 98%?

Dr. Tremblay presented data from the CANPLAY Project (CFLRI, 2008) that show that 90% of children and youth between 5 and 19 are not meeting current physical activity guidelines. He also presented data that demonstrated the dramatic increase in screen time has a direct relationship to the ballooning obesity rates in this age group. The increase in so-called ‘car-time’ and the sedentary nature of most organized sport activities also contribute to the increase in sedentary behaviour. He reported that increasingly sensitive equipment used for monitoring physical activity is more accurately capturing the


smaller, shorter bursts of activity as well as all of the total sedentary time over a 24-hour period. Dr. Tremblay emphasized that the way that sedentary time is accumulated may also play a factor; in particular, longer, uninterrupted periods of sedentary time have been shown to have a negative effect on BMI , Triglycerides, HDL, WC, BP and other markers. The long-term effect on health is largely unknown (and provides opportunities for intervention research). These factors raised further questions:

• Should we be more prescriptive with our guidance on sedentary behaviour? • Have a FITT formula for sedentary behaviour? • Consider separate guides? • Opt for separate sections? • Develop a 24-hour behaviour map?

International Initiatives (U.S., U.K., Australia, WHO) Dr. Richard Troiano, U.S., Dr. Stuart Biddle, U.K., Trevor Shilton, AU, Dr. Vanessa Candeias, WHO Four invited representatives from international groups who are currently working on or recently completed physical activity guidelines made presentations to the assembly. These presentations were very well-received and prompted much ongoing post-conference interaction among delegates and were considered by all to be an excellent value-added component. U.S. Physical Activity Guidelines Dr. Richard Troiano, Department of Health and Human Services, Washington, DC

Dr. Troiano provided an overview of the process that was followed to produce the Physical Activity Guidelines for Americans released in October 2008. A Physical Activity Guidelines Advisory Committee (PAGAC) was convened at about the same time an extensive literature review was undertaken (overseen by the CDC). The literature search focused on extracting data related to physical activity exposure elements (FITT) that influence risk factors that contribute to eight health outcomes (CVD, metabolic, musculoskeletal, cancer, functional, mental, all-cause mortality and adverse events). Approximately 15,000 abstracts were identified

as meeting the criteria for further review and 1598 papers were reviewed in detail across all health outcomes. Members of the PAGAC oversaw the work of several subcommittees representing the health outcomes that developed presentations for three public meetings (June 2007, December 2007, February 2008) and produced a 650-page report + 300 online-only tables. A writing group was formed to determine and draft the final guidelines for the approval of the HHS Secretary. Dr. Troiano profiled the comprehensive communications components (all available online) that have accompanied the Physical Activity Guide’s release, including a section for policy makers and health professionals, a toolkit for communities, the full report and accompanying document for health professionals and researchers and the P.A. Guide for Americans. (http://www.health.gov/paguidelines/)


Developments in England Dr. Stuart Biddle, Loughborough University, Loughborough, UK

Dr. Biddle provided a brief history of physical activity guidelines in England over the past 20 years. In 2004, the “Chief Medical Officer’s Report” served as a landmark in defining the current guidelines: • ‘At least five a week’ • Recommendations for active living

throughout the lifecourse • Children and young people: 60 mins “of at

least moderate physical activity … each day”; at least 2 times per week include physical activity for bone health, strength &

flexibility • Adults: “… at least 30 mins of at least moderate physical activity 5 or more days/week; min 10 min

bouts” • “Also appropriate for older people” The CMO Report also addressed specific population groups:

• Specific recommendations for different conditions - examples: • Weight management: “45-60 mins moderate physical activity … to prevent obesity” • Older adults: mobility, strength, balance

Related initiatives include the launch of the Change for Life promotional program http://www.nhs.uk/change4life/Pages/default.aspx and the Foresight program. The Foresight’s Project Aim is: "to produce a long-term vision of how we can deliver a sustainable response to obesity in the UK over the next 40 years." He reported that similar initiatives are occurring elsewhere in the UK including Scotland http://www.activescotland.org.uk. Physical activity recommendations in Australia: Process – outcomes - applications Trevor Shilton, Director, Cardiovascular Health, National Heart Foundation of Australia (WA)

Mr. Shilton provided a very comprehensive overview of the current initiatives in Australia. Australia has developed physical activity guidelines for Adults (1999), and Children/Youth (5-18) (2004), and currently intend to publish guidelines for Older Adults (2009) and Pre-school Children (0-5) (2009). Australian Physical Activity Guidelines for Adults Step 1 – Think of movement as an opportunity, not an inconvenience Where any form of movement of the body is

seen as an opportunity for improving health, not as a time-wasting inconvenience. Step 2- Be active every day in as many ways as you can Make a habit of walking or cycling instead of using the car, or do things yourself instead of using labour-saving machines. Step 3 – Put together at least 30 minutes of moderate-intensity physical activity on most, preferably all, days. You can accumulate your 30 minutes (or more) throughout the day by combining a few shorter sessions of activity of around 10 to 15 minutes each.


Step 4 – If you can, also enjoy some regular, vigorous activity for extra health and fitness This step does not replace Steps 1-3. Rather it adds an extra level for those who are able, and wish, to achieve greater health and fitness benefits. Mr Shilton outlined applications of the guidelines in a Western Australian social-marketing campaign including extensive television, print and online promotions that promotes the tagline “Find Thirty every day”. Australian Physical Activity Recommendations for Children and Youth (5-12 and 13-18 years)

1. Children and youth should participate in at least 60 minutes (and up to several hours) of moderate- to vigorous-intensity physical activity every day.

2. Children and youth should not spend more than two hours per day using electronic media for entertainment (e.g.,TV, computer games, Internet), particularly during daylight hours.

Mr. Shilton noted that the guidelines’ development process followed a similar pattern to the adult guidelines with the drafting of a scientific background paper that was used by a Steering Committee to finalize the guidelines and obtain consensus through a national consensus meeting. A national social marketing campaign was implemented to promote the messages from the Children and Youth Guidelines. A Western Australian program “Unplug and Play” focuses on the second ‘sedentariness’ guideline. Australian Physical Activity Recommendations for Older Adults

• Recently endorsed by the Australian Health Ministers’ Conference (Dec. 2008) • Developed by the National Ageing Research Institute. • They go further than the adult guidelines by placing emphasis on the need for a range of

activities including fitness, strength, balance and flexibility. • Not yet formally launched - shortly available at www.healthyactive.gov.au

Australian Physical Activity Recommendations for Older Adults:

1. Older people should do some form of physical activity, no matter what their age, weight, health problems or abilities.

2. Older people should be active every day in as many ways as possible, doing a range of physical activities that incorporate fitness, strength, balance and flexibility.

3. Older people should accumulate at least 30 minutes of moderate intensity physical activity on most, preferably all, days.

4. Older people who have stopped physical activity, or who are starting a new physical activity, should start at a level that is easily manageable and gradually build up the amount, type and frequency of activity.

5. Older people who have enjoyed a lifetime of vigorous physical activity should continue to participate at this level in a manner suited to their capability into later life, provided recommended safety procedures and guidelines are adhered to.

The Guidelines for Pre-school children are currently under development and expected to be published in late 2009. The main application of the recommendations will be:

• Promotion of consistent policy and programs for this age group • Assistance with measurement of effectiveness of programs and interventions • Assist in determining benchmarks for monitoring/determining whether 0 – 5’s undertake

sufficient physical activity


Global Recommendations on Physical Activity for Health: implementation of the WHO Global Strategy on Diet, Physical Activity and Health Vanessa Candeias, Technical Officer, Surveillance and Population-based Prevention Unit, World Health Organization, Geneva, Switzerland

Ms. Candeias provided an overview of the process currently underway to develop global physical activity recommendations. These recommendations are part of a broader strategy to develop guidelines for combating the global problem of non-communicable diseases worldwide. Physical inactivity is one of several modifiable risk factors that have been identified and a constituent of a WHO ‘Global Strategy on Diet, Physical Activity and Health’ approved in 2004. This strategy is a key contributor to the “Action Plan for the Global Strategy for the Prevention and Control of Non-communicable Diseases” endorsed by the WHO World Health

Assembly in May 2008. The recommendations will form a component of an implementation toolbox to provide resources to assist member nations in the management and implementation of the Global Strategy on Diet, Physical Activity and Health (DPAS). www.who.int/dietphysicalactivity/implementation/toolbox. A Guidelines Review Committee (GRC) has been established in WHO to oversee the development of all WHO guidelines. The “Global Recommendations on physical activity for Health” currently being prepared, will comply with the process criteria established by the WHO GRC. It is anticipated that the recommendations will be available by the end of 2009. The Guideline Review Committee “aims to ensure that WHO guidelines are consistent with internationally accepted best practices”. The main steps in guideline development include:

• Synthesis of all available evidence • Evidence summaries • Formal assessment of quality of evidence • Consideration of other factors, such as resource use and costs, ethical aspects, applicability, and

values • Linking of evidence to recommendations • Being explicit about values and judgments

The WHO has decided to use the GRADE methodology:

• Evaluating the quality of the evidence (high, moderate, low or very low) • Grading the strength of recommendations (strong, weak or using as alternative terminology:

“strong/conditional” or “strong/qualified”) The recommendations will be targeted to three age groups: youth, adults, and older adults, and will address various types of activity along with duration and intensity.


Friday January 16

Presentations on this day focussed on the identified gap areas – areas where there are currently no specific physical activity guidelines in Canada. The objective was to seek consensus from the experts present on which gap area(s) should be identified as a priority for future planning. The final presentation by Dr. Latimer provided an overview of her systematic review that addressed effective messages for promoting guidelines. Preschool Physical Activity Guidelines “Evidence” Presentation Dr. Brian Timmons, Department of Paediatrics, McMaster University, Hamilton Dr. Timmons presented an update on the current state of the evidence supporting physical activity recommendations for preschool children. The evidence currently supports the following:

• Physical health: Increasing physical activity levels by ~60 min per week (most studies use sessions of 20 min per day 3× per week) can lead to improved bone properties, motor skills, and aerobic fitness. This approach appears to have little impact on adiposity; more activity may be necessary to prevent weight gain.

• Psychosocial health: As little as 20 additional min of aerobics-type activity per day may improve aspects of self-esteem.

Dr. Timmons reported that there have been few studies in this area to date and this is partly related to the fact that pre-schoolers do not tend to engage in continuous bouts of moderate or vigorous activity for defined periods (e.g., 10-20-30 minutes). Preschoolers are more likely to engage in very brief periods of activity (e.g., 10 seconds). Evidence is now beginning to accumulate as studies are undertaken to more accurately capture activity bouts using more sensitive accelerometer technology. Dr. Timmons concluded that at present there is no strong evidence to inform physical activity guidelines and future considerations should include: the intended target audience, whether guidelines are intended to influence health in the short term or long term, motor skill development, actual physical activity behaviour among this group and whether guidelines for play might be appropriate. Considerations for the Development of a Physical Activity Guide for Canadians with Physical Disabilities Dr. Kathleen Martin Ginis, Department of Kinesiology, McMaster University, Hamilton Dr. Martin Ginis presented an update on recommendations for physical activity for persons with a disability. She noted that in general, people with disabilities are: less healthy, use more health services, have more disability days, have a shorter life expectancy , and are just as susceptible to chronic conditions (if not more so) than people without disabilities. Therefore physical activity is just as important and beneficial for this population. Dr. Martin Ginis reported that a 2001 StatCan census reported that 56% of people with disabilities were inactive (in 2006 StatCan chose not to collect data on physical activity and disabilities). Their review focused on four diseases/disabilities: fibromyalgia, multiple sclerosis, osteoarthritis / rheumatoid arthritis and spinal cord injury. They found that there is strong to moderate evidence to support the fact that physical activity alleviates symptoms, has a positive effect on aerobic fitness or strength and improves health-related quality of life for all four conditions. Dr. Martin Ginis noted that despite the clear benefits of physical activity, persons with disabilities face significant barriers. These include limited accessibility, poorly maintained sidewalks, weather, and additional financial burdens from specialized equipment, economic hardship and less value for money i.e., with gym memberships. Lack of knowledge also contributes to limiting physical activity; currently, there are no evidence-based


activity guidelines, thus this has a negative impact whereby disabled persons and their support systems, fitness professionals and others who provide services do not know how much nor what type of physical activity is beneficial or has potential to cause harm in some cases. Not only is there little information on how to be safely active, there is also information lacking on where to be active. Dr. Martin Ginis noted that there are also psychological barriers such as lack of time or motivation (same as the general population) and unique ones such as fear of pain, injury, failure, concerns about physical limitations, lack of self-confidence, embarrassment and feeling unwelcome in fitness facilities. Recommendations:

1. Physical Activity Guidelines are needed for persons with a disability to improve fitness, should include recommendations for upper and lower body activities, and suggest a wide range of activities for a wide range of abilities. Further, guidelines should provide basic, generic, physical activity principles for people with various types of physical disabilities and cautions for people with certain types of physical disabilities.

2. Physical Activity Guidelines should include information on the benefits of physical activity for persons with a disability; in particular, physical, psychosocial and overall health.

3. Physical Activity Guidelines should include strategies for overcoming barriers, link consumers with disability organizations that can provide further activity resources, and tackle public misconceptions and stereotypes —“physical activity is for all”.

Physical Activity Among Aboriginal Peoples of Canada Dr. Peter Katzmarzyk, Pennington Biomedical Research Center, Baton Rouge, Louisiana Dr. Katzmarzyk reviewed the sources of data on physical activity among Aboriginal people in Canada (there are few objective studies), and discussed what is currently known about current levels of physical activity among Aboriginal people in Canada. Aboriginal people comprise 3.4% of the population, are currently growing at twice the rate and have poorer health and a lower life expectancy than the general population. He noted that there is accumulating evidence of higher rates of several metabolic disorders among Aboriginal populations by comparison to the general Canadian population (e.g., Type 2 diabetes, cardiovascular disease, metabolic syndrome). Dr. Katzmarzyk presented data to support the fact that Aboriginal people, both in urban and rural settings, have higher prevalence of overweight and obesity in comparison to the general population, while at the same time, lower rates of physical activity. In both youth and adults, physical inactivity was associated with greater odds of being obese, independent of age, sex and ethnicity. The results of the review highlight the importance of physical activity for the maintenance of body weight, but more studies are required using objective monitoring among Aboriginal groups to better understand the relationship between physical inactivity and health risks. In terms of physical guidelines, Dr. Katzmarzyk noted that adaptations are likely needed to tailor the physical activity recommendations for maximum use and effectiveness in Aboriginal Communities. A key conclusion was that “there is as yet no scientific evidence to justify creating different physical activity recommendations for this group” than are currently recommended for the general population. Dr. Katzmarzyk concluded his presentation with the following recommendations for further research: What is Needed?

1. Descriptive data that is valid, reliable, comprehensive and representative of major regions and cultural groups across the country.

1. Studies to identify determinants and barriers to physical activity in a variety of environmental and cultural contexts.

2. Scientifically rigorous research to investigate gene-physical activity-environment interactions in the development of chronic diseases that may be unique to Aboriginal people.


4. Formal evaluations of physical activity intervention programs among Aboriginal populations. Such basic background research is a prerequisite for the development of evidence-based physical activity recommendations for a specific population. Adolescent (age 15-19) Physical Activity Guidelines Dr. Ian Janssen, School of Kinesiology and Health Studies, Queen’s University, Kingston Dr. Janssen discussed the need for physical activity guidelines for the older adolescents as this age group is not currently represented in Canada’s Physical Activity Guides for Children (6-9) and Youth (10-14). He noted that more than half of the intervention studies examined in the systematic review on youth and children extended past 14 years of age. He pointed out that few studies have systematically addressed this question or even presented results stratified by age group. The pattern of results tended to be similar in younger and older school-aged children (exception: bone health). He summarized his presentation with the following recommendations:

1. Physical activity guidelines are needed for 15 to 19 year olds. 2. Guidelines (recommendations) can be similar across the 5 to 19 year old age range. 3. Physical activity guides should be specific to smaller age brackets (e.g., 5-9, 10-14, 15-19).

Pregnancy Physical Activity Guidelines: Evidence Dr. Michelle Mottola, School of Kinesiology, University of Western Ontario, London Dr. Mottola presented an overview of the current status of guidelines for pregnant women. She noted that this population is understudied, and that prior to 1985, there were no guidelines — pregnant women were advised to rest. In 1985 the American College of Obstetricians and Gynaecologists published guidelines and these were updated in 1994 and 2002. She noted that the 2008 American Physical Activity Guidelines currently advocate:

• “Healthy women who are not already active or doing vigorous-intensity activity should get at least 150 minutes of moderate-intensity aerobic activity/week during pregnancy & postpartum. This activity should be spread throughout the week”; and,

• “Pregnant women who habitually engage in vigorous-intensity aerobic activity or who are highly active can continue physical activity during pregnancy and the postpartum, provided that they remain healthy and discuss with their health-care provider how and when activity should be adjusted over time.”

Canada’s contribution to the field has been through the development of CSEP’s comprehensive pre-screening and activity prescription tool, the “Physical Activity Readiness Medical Examination for Pregnancy (PARmed-X for Pregnancy)” and the 2003 “Joint SOGC / CSEP Clinical Practice Guidelines: Exercise in Pregnancy and the Postpartum Period" (Davies et al., 2003). Dr. Mottola noted that the latter document used levels of evidence for the recommendations. Dr. Mottola noted that both the Canadian documents should be reviewed and updated based on recent evidence. Ongoing questions to be addressed by future reviews include:

1. Is exercise safe? And what is the impact on pregnancy outcome/ birth weight; 2. Does being active decrease chronic disease risk? Assess epidemiological studies to examine

decreasing incidence of GDM / pre-eclampsia; 3. Fetal imprinting – is there a relationship between the fetal environment and chronic disease

risk?


A systematic review of Strategies for Developing Effective Messages Promoting Physical Activity Dr. Amy Latimer, Queen’s University, Kingston, Ontario Dr. Latimer’s presentation focused on the evidence that underlies effective messages to promote physical activity. She set the topic into context with several definitions: A Guideline would state: “Scientists say accumulate 60 minutes of physical activity every day to stay healthy or improve your health.” Messages to promote the Guideline: “Physical activity doesn’t have to be very hard. Build physical activities into your daily routine.” Messaging: the means of conveying the above – Mode of Delivery (print, mass media, telephone, and online messaging all have potential as strategies for communicating physical activity messages) and Context (tailored to the audience). Dr. Latimer reported that the purpose of the review was to examine research that may be used to inform the construction of any future messages for disseminating Canada’s Physical Activity Guidelines. The review was divided into three focus areas:

• Message tailoring — whether tailoring optimizes the impact of messages on behaviour. • Message framing — the emphasis of a message on the positive or negative consequences of

adopting, or failing to adopt a particular behaviour. The review examined whether gain-framed information enhances the persuasiveness of messages to affect change in physical activity determinants and behaviour.

• Developing self-efficacy — identify appropriate message content for developing self-efficacy to initiate and maintain physical activity. The review examined studies that: directly manipulated sources of information that affect self-efficacy; randomized controlled experiments testing a message targeting self-efficacy; or used measures of perceived behavioural control to assess self-efficacy.

Dr. Latimer reported that four major databases were searched using a defined set of search terms (MEDLINE, PsycINFO, EMBASE, CINAHL). An initial yield of 12,405 citations was returned and after screening and a secondary search, 22 articles were selected for the review. Recommendations: Message tailoring:

• Messages should accompany Canada’s Physical Activity Guides. • Tailoring these messages is not essential, however, when the medium for dissemination is

suitable, tailoring should be considered • If tailoring is used, multiple exposures seem beneficial

Message framing: • Until there is evidence to the contrary, it seems prudent to gain-frame physical activity

messages especially if they come from a credible source and target inactive adults. • The source of CPAG messages should be emphasized if recipients consider the source credible.

Developing Self-efficacy: • When messages are aiming to increase self-efficacy to initiate physical activity, information that

emphasizes mastery and control may be effective. Examples include: providing “how-to” information; stressing the ease of engaging in physical activity.

Dr. Latimer concluded with a recommendation that more research isolating critical message characteristics should be considered to enhance this area of study.


Expert Panel Members Expert Panel members were selected for their considerable expertise and experience. The panel was constituted to be as objective as possible with regard to the presentations of evidence. Therefore, three members including the chair (a majority), were from outside the physical activity field and two members had physical activity expertise but had not been part of the project to date. Panel Chair: Antero Kesaniemi, MD, PhD

Chief, Professor of Internal Medicine, Department of Internal Medicine, University of Oulu and Oulu University Hospital Currently project leader studying the Genetic and Metabolic Background of Atherosclerosis at the Biocenter Oulu, University of Oulu. http://www.biocenter.oulu.fi/projects/kesaniemi.html

Licenciate of Medicine (graduation), University of Helsinki 30th October 1970 Licenced Physician 30th October 1970 Educational Council for Foreign Medical Graduates (ECFMG) Examination 15th September1971 Doctor of Medical Sciences (Ph.D. Thesis), University of Helsinki 9th April 1974 Specialist in Internal Medicine, University of Helsinki 21st December 1978 Docent in Internal Medicine, University of Helsinki 11th May 1983 Leadership and development of organization (training sessions) Oulu University Hospital

January 1998-May 1999

Pfizer Academy theoretic course ”Strategic leadership II” 21st -22nd November 2003 Finnish Cardiac Society satellite symposium, Levi, Finland 2nd - 4th April 2004 Participated in the training session “Pedagogics and tutoring in the training speciality” organized by Oulu University, Faculty of Medicine

22nd April 2004

Health Care Leadership - Training program of Strategic Leadership October - December 2004 AWARDS AND HONOURS

School for officers in the Reserves, graded excellent 1964 Medal of the Infantry Foundation 1964 Invited Visiting Professor, William N. Creasy, Visiting Professor Award, University of Kansas Medical Center, USA

1990

The Lecturer of the Year, elected by the Medical Students in the University of Oulu 1995 Knight First Class of the Order of the White Rose of Finland 1995 Golden Medal by the Finnish Heart Association for active and meritful action for the promotion of heart health

2002

Invited speaker at the Meilahti Lecture 2002 The Finnish Academy of Science and Letters, Invited Member 2003 The Pentti Halonen Medal for the contribution to the Cardiovascular Research by the Finnish Heart Foundation

2004

Grand Price by the Finnish Foundation for Cardiovascular Research for cardiovascular research 2007


Panel Members: Steven Blair, PED

Professor, Departments of Exercise Science and Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC http://www.sph.sc.edu/facultystaffpages/facstaffdetails.php?ID=333 Biographical Information: 1962, B.A., Physical Education, Kansas Wesleyan University 1965, M.S., Physical Education, Indiana University 1968, P.E.D., Physical Education, Indiana University 1978-80, Post-doctoral scholar in preventive cardiology, Stanford

University, Palo Alto, California Honorary Doctoral Degrees: * Doctor Honoris Causa, Free University of Brussels, Belgium * Doctor of Health Science degree, Lander University, USA * Doctor of Science Honoris Causa, University of Bristol, UK Awards:

* MERIT Award from the National Institutes of Health * Robert Levy Lecture Award from the American Heart Association * Surgeon General's Medallion * Honor Award from the American College of Sports Medicine

Interest: The associations between lifestyle and health, with a specific emphasis on exercise, physical fitness, body composition, and chronic disease Bruce Reeder,MD, DTM&H, MHSc, FRCPC

Professor Department of Medicine Department of Community Health and Epidemiology University of Saskatchewan Saskatoon, Saskatchewan CANADA Research Interests

• Design of effective nutrition intervention programs • Enhancing the cardiovascular disease preventive practices of family

physicians in several satellite practices in the provinces • Cardiovascular health with a focus upon enhancing and measuring the dissemination of heart

health promotion innovations • Evaluation of computerized administrative databases of Saskatchewan Health • The relationship of obesity to cardiovascular disease and its risk factors

Education * F.R.C.P.C., Royal College of Physicians and Surgeons of Canada, 1987 * M.H.Sc., University of Toronto, 1986 * D.T.M.& H., University of Liverpool, 1978


* M.D., University of Saskatchewan, 1976 Chris Riddoch, PhD

Current Professor-School for Health, Professor of Sport and Exercise Science, University of Bath, January 2007 - to date Previous Professor of Sport and Exercise Science, Middlesex University, January 2003 - December 2006 Senior Lecturer, University of Bristol, January 1990 - December 2002 Lecturer, Queens University, September 1984 - August 1990

Qualifications PhD in Exercise Physiology, Queens University, Belfast. Awarded September 1990 MEd in Educational Management, University of Bristol. Awarded September 1983 BA in Educational Studies, Open University. Awarded September 1981 Cert Ed in Physical Education, Borough Road College. Awarded September 1974 Research Collaboration • Physical Activity Pooling Project, PI, September 2008 - August 2009

University of Bristol Cambridge University Project to pool physical activity data from 15 international research teams

• Avon Longitudinal Sudy of Parents and Children - childhood obesity, Principal Investigator, May 2003 – July University of Bristol, UK University of South Carolina, USA University College London, UK University of Glasgow, UK MRC Epidemiology Unit, Cambridge, UK The Avon Longitudinal Study of Parents and Children (ALSPAC): I have been PI on this project since 2003. We have received $4m dollars of funding for the period 2003-11, to study the development of childhood obesity and physical activity patterns throughout adolescence. ALSPAC is a birth cohort study (n=~14,000) started in 1990.

• European Youth Heart Study, Scientific Director, October 1996 – September University of Southern Denmark, Denmark University of Tartu, Estonia Technical University of Lisbon, Portugal University of Iceland, Iceland University of Oslo, Norway University of Castilla La Mancha, Toledo, Spain I set up and directed this large multi-national study for its first 10 years. I continue to work on the Scientific Committee as International Co-ordinator.

?


Thorkild I.A. Sørensen, MD

Thorkild I.A. Sørensen, born in 1945, became MD in 1971 and achieved the doctoral degree (Dr Med Sci) in 1983 at the University of Copenhagen. He received his clinical training at several university hospitals in Copenhagen, and became chairman of the department of emergency admissions and chief physician at the department of hepatology at Hvidovre University Hospital in 1988. In 1989, he received a 5-year position as MRC professor of clinical epidemiology, and at the end of this period in 1994, he was appointed as full professor of clinical epidemiology at the University of Copenhagen in combination with a position as chief physician in clinical epidemiology at the Copenhagen Hospital Corporation. In 1993, he became Director of the Institute

of Preventive Medicine. He was Dean of the Faculty in 1995-96. He has published more than 300 papers in international peer-reviewed journals with several papers in high-impact journals (see link or PubMed 'Sorensen TI'). The main topics of his research have been various aspects of obesity, alcohol drinking, liver and gastrointestinal disorders, addressed by methods in clinical, genetic and general epidemiology. He is coordinator of several national and international research projects and networks. He has been and is advisor, supervisor or reviewer of multiple doctoral and PhD dissertations, and has been involved in establishing a graduate school in public health sciences. He has served as scientific advisor or reviewer for many different national and international institutions, organisations and journals. Conference Delegates Mark Tremblay, Ph.D. (Chair)

Children’s Hospital of Eastern Ontario, Ottawa CAN Antero Kesaniemi, M.D., Ph.D.

Department of Internal Medicine, University of Oulu, FI Bruce Reeder, M.D., MHSc, FRCPC

Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK CAN

Chris Riddoch, Ph.D. School for Health, Bath University, Bath, UK

Thorkild Sorensen, Dr.Med.Sci. Professor of Clinical Epidemiology and Institute Director, Institute of Preventive Medicine, Copenhagen University Hospital, Copehagen, Denmark

Steven Blair, Ph.D. Dept of Exercise Science, University of South Carolina, Columbia, SC USA

Ian Janssen, Ph.D. School of Kinesiology and Health Studies, Queen’s University, Kingston, ON CAN

Darren Warburton, Ph.D. School of Human Kinetics, University of British Columbia, Vancouver, BC CAN

Donald Paterson, Ph.D. School of Kinesiology, The University of Western Ontario, London, ON CAN

Amy Latimer, Ph.D. School of Kinesiology and Health Studies, Queen’s University, Kingston, ON CAN

Ryan Rhodes, Ph.D. Behavioural Medicine Laboratory, Faculty of Education, University of Victoria, Victoria BC CAN

Vanessa Candeias Department of Chronic Diseases and Health Promotion, World Health Organization, Geneva

Stuart Biddle, Ph.D. School of Sport and Exercise Sciences, Loughborough University, Leicestershire, UK


Richard Troiano, Ph.D. U.S. Dept of Human Health Services, Office of Public Health and Science, Washington, DC USA

Trevor Shilton National Heart Foundation of Australia (WA), Perth, Australia

Brian Timmons, Ph.D. Pediatrics, Chedoke-McMaster Hospital, Hamilton, ON CAN

Michelle Mottola, Ph.D. School of Kinesiology, The University of Western Ontario, London, ON CAN

Kathleen Martin Ginis, Ph.D. Dept of Kinesiology McMaster University, Hamilton, ON CAN

Peter Katzmarzyk, Ph.D. Pennington Biomedical Research Center, Baton Rouge, LA USA

William Haskell, Ph.D. Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA USA

Roy Shephard, M.D., Ph.D., D.P.E. Professor Emeritus, Faculty of Physical Education and Health, University of Toronto, ON CAN

I-Min Lee, M.D., Sc.D. Department of Epidemiology, Harvard School of Public Health, Boston, MA USA

Norm Gledhill, Ph.D. School of Kinesiology and Health Science, York University, Toronto ON CAN

James Stone, M.D., Ph.D., FRCPC Department of Cardiology, Foothills Hospital, Calgary, AB CAN

Russell Pate, Ph.D. Arnold School of Public Health, University of South Carolina, Columbia, SC USA

Rod Dishman, Ph.D. College of Education, University of Georgia, Athens, Georgia USA

Van Hubbard, M.D., Ph.D. National Institutes of Heath, Division of Nutrition Research Coordination, Bethesda, MD, USA

Michelle Kho, Ph.D.(c) McMaster University, Hamilton, ON CAN

Andrea Tricco, Ph.D.(c) (Systematic Reviews) (by telephone) University of Ottawa, Ottawa, ON CAN

Christine Cameron Canadian Fitness and Lifestyle Research Institute, Ottawa, ON CAN

Lawrence Brawley, Ph.D. College of Kinesiology, University of Saskatchewan, Saskatoon, SK CAN

Lori Zehr Centre for Sport & Exercise Education, Camosun College, Victoria BC CAN

Brian MacIntosh, Ph.D. Faculty of Kinesiology, University of Calgary, Calgary, AB CAN

Angelo Belcastro, Ph.D. Faculty of Kinesiology, University of New Brunswick, Fredericton, NB CAN

Mary Duggan Manager, Canadian Society for Exercise Physiology, Ottawa, ON CAN

Ashlee McGuire, Ph.D.(c) School of Kinesiology and Health Studies, Queen’s University, Kingston, ON CAN

Sarah Charlesworth, Ph.D. School of Human Kinetics, University of British Columbia, Vancouver, BC CAN

Kelly Murumets President and CEO, ParticipACTION, Toronto, ON CAN

Art Salmon, Ed.D. Team Leader: Research, Ont. Min Health Promotion, Toronto, ON CAN

Isabel Romero Director, Healthy Communities Division, Public Health Agency of Canada, Ottawa, ON CAN

Randy Adams Research Manager, Public Health Agency of Canada, Ottawa, ON CAN

Halina Cyr Director, Chronic Disease and Injury Prevention Division, First Nations and Inuit Health Branch, Health

Canada, Ottawa, ON CAN Julie Pinard

Physical Activity Specialist, First Nations and Inuit Health Branch, Health Canada, Ottawa, ON CAN

2009 Consensus Conference - CSEP · 2009 Consensus Conference – Advancing the Future of Physical...

Documents

Transcript of 2009 Consensus Conference - CSEP · 2009 Consensus Conference – Advancing the Future of Physical...