Chapter 8: Taking Action: Increasing Physical Activity Levels of Americans
The low level of physical activity among Americans is a major contributor to the burden of chronic disease. This burden is costly in terms of quality of life and economic resources needed to provide medical care. Like life in other modern societies around the world, life in the United States requires very little daily physical activity. The amount of physical activity we do is largely a matter of personal choice and the environmental conditions under which we live. So far, little progress has been made in meeting our national health objectives for physical activity.
Based on a careful review of the science, the Physical Activity Guidelines provides essential guidance to help Americans achieve the health benefits of regular physical activity. However, providing guidance by itself is not enough to produce change. Action is necessary. Regular physical activity needs to be made the easy choice for Americans.
To accomplish this goal, public health research suggests the use of a "socio-ecologic" approach. This comprehensive approach involves action at all levels of society: individual, interpersonal, organizational, community, and public policy. Example actions include:
For More Information
See Appendix 3—Federal Web Sites That Promote Physical Activity, for useful resources at all these levels.
- Personal goal setting (individual level);
- Social support and encouragement to be active (interpersonal level);
- Promotion of physical activity as part of worksite health promotion programs (organizational);
- Good access to parks and recreational facilities in neighborhoods (community); and
- Promotion of policies that support families who want their children to walk or bike to school (public policy).
To give a sense of how to make regular physical activity the easy choice, the remainder of this chapter first considers steps individuals can take to adopt an active lifestyle. Then it considers steps society can take to support and facilitate active lifestyles.
The purpose is to illustrate achievable steps that will make a difference, not to address everything that needs to be done.
What Can Adults Do To Get Enough Physical Activity?
Adults can find advice on how to be active from many sources, including fitness professionals, health-care providers, books, and Web sites. Here are three commonly cited steps adults can take to help meet the Guidelines.
Personalize the Benefits of Regular Physical Activity
Adults need to identify benefits of personal value to them. For many people, the health benefits, which are the focus of the Physical Activity Guidelines for Americans, are compelling enough. For others, different reasons are key motivators to be active. For example, physical activity:
- Provides opportunities to enjoy recreational activities, often in a social setting;
- Improves personal appearance;
- Provides a chance to help a spouse lose weight;
- Improves the quality of sleep;
- Reduces feelings of low energy; and
- Gives older adults a greater opportunity to live independently in the community.
Set Personal Goals for Physical Activity
The Guidelines alone don't provide enough information for individuals to decide the types and amounts of activity that are appropriate for them. Individuals should set goals for activity that allow them to achieve benefits they value. Simple goals are fine. For example, a brisk walk in the neighborhood with friends for 45 minutes 3 days a week and walking to lunch twice a week may be just the right approach for someone who wants to increase both physical activity and social opportunities.
In setting goals, people can consider doing a variety of activities and try both indoor and outdoor activities. In particular, public parks and recreation areas in the United States offer opportunities to experience nature and be physically active at the same time.
The best physical activity is the one that is enjoyable enough to do regularly.
Develop Knowledge To Attain Goals
It is important to learn about the types and amount of activity needed to attain personal goals. For example, if weight loss is a goal, it's useful to know that vigorous-intensity activity can be much more time-efficient in burning calories than moderate-intensity activity. If running is a goal, it's important to learn how to reduce risk of running injuries by selecting an appropriate training program and proper shoes. If regular walking is a goal, learning about neighborhood walking trails can help a person attain the goal.
Using a Pedometer To Track Walking
For adults who prefer walking as a form of aerobic activity, pedometers or step counters are useful in tracking progress toward personal goals. Popular advice, such as walking 10,000 steps a day, is not a Guideline per se, but a way people may choose to meet the Guidelines. The key to using a pedometer to meet the Guidelines is to first set a time goal (minutes of walking a day) and then calculate how many steps are needed each day to reach that goal.
Episodes of brisk walking that last at least 10 minutes count toward meeting the Guidelines. However, just counting steps using a pedometer doesn't ensure that a person will achieve those 10-minute episodes. People generally need to plan episodes of walking if they are to use a pedometer and step goals appropriately.
As a basis for setting step goals, it's preferable that people know how many steps they take per minute of a brisk walk. A person with a low fitness level, who takes fewer steps per minute than a fit adult, will need fewer steps to achieve the same amount of walking time.
One way to set a step goal is the following:
- To determine usual daily steps from baseline activity, a person wears a pedometer to observe the number of steps taken on several ordinary days with no episodes of walking for exercise. Suppose the average is about 5,000 steps a day.
- While wearing the pedometer, the person measures the number of steps taken during 10 minutes of an exercise walk. Suppose this is 1,000 steps. Then, for a goal of 40 minutes of walking for exercise, the total number of steps would be 4,000 (1,000 Ã— 4).
- To calculate a daily step goal, add the usual daily steps (5,000) to the steps required for a 40-minute walk (4,000), to get the total steps per day (5,000 + 4,000 = 9,000).
Each week the person gradually increases the time walking for exercise until the step goal is reached. Rate of progression should be individualized. Some people who start out at 5,000 steps a day can add 500 steps per day each week. Others, who are less fit and starting out at a lower number of steps, should add a smaller number of steps each week.
How Can We Help Children and Adolescents Get Enough Physical Activity?
Many children and adolescents are naturally physically active, and they need opportunities to be active and to learn skills. They benefit from encouragement from parents and other adults. Adults can promote age-appropriate activity in youth through these steps:
- Provide time for both structured and unstructured physical activity during school and outside of school. Children need time for active play. Through recess, physical activity breaks, physical education classes, after-school programs, and active time with family and friends, youth can learn about physical activity and spend time doing it.
- Provide children and adolescents with positive feedback and good role models. It has been said that if you do not practice what you teach, you are teaching something else. Parents and teachers should model and encourage an active lifestyle for children. Praise, rewards, and encouragement help children to be active. Using physical activity as punishment does not help children to be active.
- Help young people learn skills required to do physical activity safely. As appropriate for their age, youth need to understand how to regulate the intensity of activity, increase physical activity gradually over time, set goals, use protective gear and proper equipment, follow rules, and avoid injuries.
- Promote activities that set the basis for a lifetime of activity. Children and adolescents should be exposed to a variety of activities, including active recreation, team sports, and individual sports. In this way, they can find activities they can do well and enjoy. Include exposure to activities that adults commonly do, such as jogging, bicycling, hiking, and swimming. Young people should experience non-competitive activities and activities that do not require above-average athletic skills.
Communities can provide many opportunities for physical activity, such as walking trails, bicycle lanes on roads, sidewalks, and sports fields.
What Can Communities and Government Do To Help People Be Active?
Actions by communities and government can influence whether regular physical activity is an easy choice. Communities can provide many opportunities for physical activity, such as walking trails, bicycle lanes on roads, sidewalks, and sports fields. Organizations in the community have a role to play as well. Schools, places of worship, worksites, and community centers can provide opportunities and encouragement for physical activity.
Use Evidence-Based Approaches and Tailor Them to the Needs of Individual Communities
To be effective, physical activity promotion efforts should use an "evidence-based" approach. The CDC's Guide to Community Preventive Services1 has reviewed many community-level approaches to promote physical activity, including these five strongly recommended strategies:
- Community-wide campaigns that combine physical activity messaging (distributed through television, newspapers, radio, and other media) with activities such as physical activity counseling, community health fairs, and the development of walking trails.
- Point-of-decision prompts to encourage stair use. These are signs placed at points where people make the decision either to use the stairs or to use an elevator or escalator. The signs encourage the active option of stair use.
- Physical education classes to increase activity. Physical education classes should use a curriculum that increases the amount of time students are active during class.
- Approaches that increase the reach of individual-level interventions. For example, evidence-based, individual-level interventions can reach more people when they are delivered in group settings or over the telephone.
- Interventions that increase social support for physical activity. These interventions start or enhance social-support networks, and include efforts such as organizing a buddy system (two or more people who set regular times to do physical activity together), walking groups, and community dances.
- Programs to create or enhance access to places to be physically active. This can include building walking trails and providing public access to school gymnasiums, playgrounds, or community centers. This also includes worksite activity programs that provide access to onsite or offsite fitness rooms, walking breaks, or other opportunities to engage in physical activity. Interventions to improve access should also include outreach that increases awareness of the opportunity to be active.
Implementing community-level approaches to physical activity requires collaboration across sectors.
Involve Many Sectors in Promoting Physical Activity
Interventions to improve access should also include outreach that increases awareness of the opportunity to be active.
- Policies and programs that support street-scale design principles and practices that promote physical activity. For example, these types of policies and programs use crosswalks, sidewalks, traffic calming, and other safety measures to make it easier and safer for people to choose active transportation.
- Policies and programs that support community- scale design principles and practices that promote physical activity. Community-scale design includes zoning that facilitates bicycling and walking by allowing schools, housing, and businesses to be built near one another.
The following list identifies relevant sectors and illustrates roles they play in promoting physical activity. The division of functions in the community into the following sectors does not use mutually exclusive categories. These sectors were chosen simply to illustrate how parts of the community have a role to play in promoting physical activity. Some communities may use different names and divisions of functions.
- Parks and recreation. This sector plays a lead role in providing access to places for active recreation, such as playgrounds, hiking and biking trails, basketball courts, sports fields, and swimming pools.
- Law enforcement. Concern about crime can deter people from outdoors recreation. Law enforcement can promote a safe environment that facilitates outdoor activity.
- Urban planning. Urban planning. The Guide to Community Preventive Services recommends both street-scale and community-scale design principles to promote physical activity. Urban planners have a lead role in implementing design principles to promote physical activity.
- Transportation. The transportation sector has a lead role in designing and implementing options that provide areas for safe walking and bicycling. Mass transit systems also promote walking, as people typically walk to and from transit stops. Programs that support safe walking and bicycling to school help children be more physically active.
- Education. The education sector takes a lead role in providing physical education, after-school sports, and public access to school facilities during after-school hours.
- Architecture. Architects and builders can design and construct buildings with active options, such as access to stairs. Campuses should allow pedestrians pleasant and efficient methods of walking within and between buildings.
- Employers and private organizations. Employers and private organizations. Employers can encourage workers to be physically active, facilitate active transportation by supplying showers and secure bicycle storage, and provide other incentives to be active. Private and faith-based organizations can support community physical activity initiatives financially or by providing space for programs. Health and fitness facilities and community programs can provide access to exercise programs and equipment for a broad range of people, including older adults and people with disabilities. Local sports organizations can organize road races and events for the public. Senior centers can provide exercise programs for older adults.
- Health care. Health-care providers can assess, counsel, and advise patients on physical activity and how to do it safely. Health-care providers can model healthy behaviors by being physically active themselves.
- Public health. Public health departments can monitor community progress in providing places and opportunities to be physically active and can track changes in the proportion of the population meeting the Physical Activity Guidelines for Americans. They can also take the lead in setting objectives and coordinating activities among sectors. Public health departments and organizations can disseminate appropriate messages and information to the public about physical activity.
The Physical Activity Guidelines for Americans gives guidance on the amount of physical activity that will provide health benefits for all Americans. Broad, comprehensive strategies are needed to help all Americans meet the Guidelines. Implementing a comprehensive strategy to increase physical activity requires an evidence-based approach that occurs at multiple levels and in all sectors. A comprehensive and coordinated strategy will help Americans take action to ensure that regular physical activity is the easy and accepted choice for everyone.
1 Centers for Disease Control and Prevention. (Last updated February 21, 2008). Physical Activity. In Guide to Community Preventive Services Web site. Retrieved April 17, 2008, from www.thecommunityguide.org/pa.
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