DNPAO Message Information Session
Increasing Physical Activity:
Guidance Document Strategies
State Nutrition, Physical Activity
And Obesity Program
Annual Training Meeting
March 18, 2010
Guidance DocumentBackground
• Purpose:
To help guide the selection of intervention strategies from among the many available
• What the document is not:
It is not meant to be prescriptive. It is not all-inclusive, and the levels of evidence vary.
• How were the strategies selected?
Each guidance document used the highest level of evidence available for the recommended strategies.
Physical Activity Guidance Document
• How were the physical activity strategies selected?
Eight strategies are recommendations of the U.S. Task Force on Community Preventive Services.
Two additional evidence-based strategies were selected on the basis of scientific evidence or expert panel recommendations.
So………why is it important to promote physical activity?
• Health benefits
• Physical activity guidelines
• Physical activity prevalence
•30% risk reduction in all cause mortality
•20-35% lower risk for CVD, CHD, Stroke
•30-40% lower risk of type 2 diabetes
•30% lower risk of colon cancer, 20% lower for breast cancer
•20-30% lower risk for depression, distress and dementia
•36-68% lower hip fracture risk
Physical Activity Health Benefits
Weight-related Benefits ofPhysical Activity
Weight Stability•Regular PA provides benefits for weight stability
Weight Regain•More PA is better to help prevent regain of lost weight
Weight Loss•More than 5% of body weight difficult without reduced calorie intake
PA Recommendations: Adults
• All adults should avoid inactivity, adults who participate in any activity gain some health benefits
• 150 minutes of moderate-intensity activity or 75 minutes of vigorous, or a combination of both, per week.
• For additional and more extensive benefits, do 300 minutes of moderate or 150 minutes of vigorous per week
Children and adolescents should do 60 minutes (1 hour) or more of physical activity daily.
• Aerobic: Most of the 60 or more minutes a day should be either moderate- or vigorous-intensity aerobic physical activity, and should include vigorous-intensity physical activity at least 3 days a week.
• Muscle-strengthening: As part of their 60 or more minutes of daily physical activity, children and adolescents should include muscle-strengthening physical activity on at least 3 days of the week.
• Bone-strengthening: As part of their 60 or more minutes of daily physical activity, children and adolescents should include bone-strengthening physical activity on at least 3 days of the week.
Children and Adolescents
Reported Total Weekly Aerobic Physical Activity – BRFSS, 2007
22.0%
45.9%
18.6%13.5%
0
10
20
30
40
50
60
70
80
90
100
Highly Active (>300min/wk)
Active (150-299min/wk)
Insufficiently Active(10-149 min/wk)
Inactive (<10min/wk)
Pre
va
len
ce
64% Meet 2008 PAG 35.5% Not Meeting 2008
Recommended Physical Activity Intervention Strategies
• Three broad domains align with levels of behavioral influence:
– Informational
– Social and Behavioral
– Environmental and Policy Top three – potential reach and impact
Strategy 1: *Community-wide Campaigns
Strong evidence• Large scale, high visibility campaigns• Mass media messages• Support through various sectors in the targeted
community• Emphasis on policy and environmental change
*One of the top three recommended strategies
Strategy 2: *Create or Enhance Access to Places for PA Combined with Informational
Outreach
Strong evidence• Long-term efforts in worksites and/or communities to
improve PA opportunities• Environmental changes:
1.Create walking trails
2.Create exercise facilities
3.Better access to nearby facilities
*One of the top three recommended strategies
Kona, HI
ogging Path
Strategy 3: *Enhanced Physical Education in Schools
Strong evidence• Increase length of time that youth are active in PE
classes• Can be applied in various youth-oriented settings, such
as community recreation centers and after-school programs
*One of the top three recommended strategies
CATCH PE
• Increase MVPA to 40%• Teacher training and on-site TA• Policy – PE 90 minutes/3x wk• Curriculum – activity selection &
modification• Teaching and class management
strategies
Strategy 4: Point of Decision Prompts for Promoting PA
Strong evidence• Signage placed at the point where
decisions are made:1. Stairwells
2. Escalators
CDC’s StairWELL to Better Health
Strategy 5: Social Support Interventions in Community
Settings
Strong evidence• Build, strengthen and maintain social networks• Buddy systems• Walking clubs• Contracts
Strategy 6: Individually Adapted Health Behavior Change
Strong evidence• Tailored based on readiness for change• Target daily routines• Build social support• Prevent relapse into inactivity
Personal Empowerment Plan
• 12 week self-directed worksite program
• Targets stages of change
• Coordinator kit & promo materials
• Worksites can add activities
• revised/expanded
• Cooper Institute
Strategy 7: Street Scale Urban Design and Land Use to Promote
PA
Sufficient evidence• Local changes to support PA within a few blocks• Policies to improve lighting, traffic calming, etc.
Strategy 8: Community-Scale Urban Design, Land Use Policies &
Practices
Sufficient evidence• Target geographic areas to support PA• Policies and practices to develop/improve:
– Streets– Sidewalks and bike lanes
Community Design
Strategy 9: Active Transport to School
National Safe Routes to School Task Force found that SRTS interventions can be effective in increasing
physical activity and creating infrastructure to support physical activity.
• Supports youth in walking, bicycling, or skating to school• May involve urban design, land use policies, and
community• Includes neighborhood efforts (e.g. walking school bus)• 100’s of millions of dollars available!
CDC’sKidswalk-to-School
• Increase daily physical activity of children
• Improve pedestrian safety
• Educate and empower communities to create safe routes to school
Strategy 10: Transportation and Travel Policies and Practices
NICE (UK) review examined 26 studies and found that:
• Traffic calming• Introduction or expansion of multi-use trails• Closing or restricting use of road by motorized traffic• Road user charges• Improved cycling infrastructure• Safe routes to schoolResulted in increases in walking, cycling, and outdoor play
Intervention Characteristics
• Policy measures, e.g. roadway design standards
• Expanding public transportation services
• Subsidizing public transportation
• Providing bicycle lanes and racks
• Increasing the cost of parking
Key considerations for intervention selection
• Reach
• Acceptability
• Feasibility
• Sustainability
• Adaptability
Local adaptation
• Consider Social Ecological Model
• Realize that ALL interventions need some level of adaptation
• Seek out other forms of evidence (e.g., political will, stakeholder interests, evidence-based practice)
• Evaluate
Thank you
The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the
Centers for Disease Control and Prevention.
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