June 28 - 29, 2007 Advisory Committee Meeting Minutes
Review of Timeline, Milestones, and Process
Dr. Haskell reviewed the overall timeline for the Committee indicating tentative Committee Meetings scheduled for December 2007 and February 2008. In order to support the work of the Committee, Dr. Kohl and a team at CDC instituted an extensive and comprehensive process of reviewing and abstracting key scientific literature on physical activity and health in early 2007. The Committee, from now until December, will review, interpret and prepare preliminary reports based on best science. Between November 2007 and February 2008 the Committee will continue to address key issues raised by Committee Members with the goal of producing a written report by February 2008. HHS in turn has a tentative goal of producing Guidelines no later than October 2008.
Dr. Haskell then stated the next step for the Committee would be to organize into sub-committees; however, the Committee as a whole should agree with this process. Committee members would chair the sub-committees and be free to recruit additional experts outside of the Committee to provide assistance and input. CDC will provide each sub-committee assistance should additional literature be required. HHS in turn will provide additional administrative support as needed. Dr. Haskell noted that he, Dr. Nelson and Dr. Kohl would serve as a working group to facilitate requests from the Committee to CDC.
Dr. Haskell noted throughout the agenda of this meeting Committee Members will be addressing topics based on health outcomes. He raised the question whether the Committee's work should be based on health outcomes? Part of the rationale for organizing in this manner is that most studies are outcome oriented, many physical activity scientists are structured by disease outcomes and the initial literature review conducted by CDC is organized by disease outcomes. The Committee would start reviewing and interpreting the literature and write statements about the relationship between physical activity and specific outcomes. Major challenges for the Committee include determining how to get the scientific review completed and presenting the interpretation of the science in a manner that HHS can utilize to develop policies.
CAPT Troiano commented that work performed by sub-committees must also eventually be presented and approved by the full Committee, allowing the general public to observe and comment, due to the fact the Committee is operating under the Federal Advisory Committee Act. Sub-committee members should be thought of as consultative members that will assist the Committee through their expertise in a particular field. There is no specific process for recruiting sub-committee members and staff will make sure they are properly credited for work performed.
Several Committee Members commented on the issue of organizing work around health outcomes since the interpretation of the science will eventually have to deal with exposures and specific sub-groups. Concern was expressed over the relative limited time available to produce the report which is why basing initial work of the Committee around health outcomes will allow for a more rapid review of the literature. It was noted while conducting the literature review it may be possible and beneficial to acknowledge exposures at the same time, especially if Committee Members can agree up front what the major issues are from an exposure perspective within each specific outcome. Dr. Haskell commented that a portion of the report could look like tables from systematic scientific reviews – a concise interpretation of the science.
An additional concern regarding levels of evidence and the unevenness of evidence in certain population sub-groups was raised by the Committee. Accordingly, to what extent does the interpretation of the science need to be slightly unique for a particular sub-group in which very little data exists. Dr. McTiernan suggested as sub-committees start their work there should be an agreed-upon list of sub-groups and particular exercise types so that there is some commonality to everyone's approach. Dr. Nelson commented that the Dietary Guidelines were really written around exposures and that if the Physical Activity Guidelines are to complement the Dietary Guidelines the Committee's work should address exposures or be considered in parallel with work done revolving around outcomes.
Dr. Yancey asked to what extent will the Committee deal with implementation methods? In response, Dr. Haskell reiterated that their charge was to document what the science is relating physical activity to health and not to evaluate the increasing number of intervention trials that are trying different strategies to get different populations more physically active. Dr. Haskell also stated while it was not the job of the Committee to evaluate implementation it might be helpful to note the type of delivery that was employed (i.e., home-based, lifestyle, etc.) when reviewing the study.
Further commenting on the issue of levels of evidence, Dr. Rimmer stated that persons with disabilities is an important group to recognize; however, level A type evidence may not exist for several disability sub-groups. On the other hand there is a lot of level B and C type evidence so it may not be appropriate to base the same model used for other outcome groups when reviewing the evidence in disability sub-groups. Dr. Haskell responded that Dr. Rimmer's comments speak directly to a central dilemma of how to apply level-of-evidence concept to a behavioral intervention since it is difficult to create randomized trials, similar to pharmaceutical drug trials, and how does the Committee weigh the different levels of evidence?
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