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Mike Eisenhart PT

11/10/2017

To the Committee -

On behalf of our Academy (APHPT), I am submitting the following comments for consideration.

(1) A continued emphasis on proper dosage of physical activity is of utmost importance. Helping the population understand concepts related to total volume and not just duration, perhaps by greater emphasis on accurate capture of effort (MET-minutes, etc) is critically important. We are very hopeful that there will be continued movement in the direction of exercise volume measures that incorporate frequency, duration and intensity in the recommendations as well as calls for provider training and support on proper prescription and referral along these lines.

(2) Although physical activity of any type is largely beneficial, we run the risk of assuming that such a level of activity will be inherently rewarding. As evidenced in nearly every media channel, Americans are enduring a pain crisis which has manifested in a rampant drug epidemic. We believe strongly that at the root of this pain crisis is inadequate priority placed on healthy and safe movement across the lifespan as well as in special populations. Understanding personal movement capacity as well as how to safely increase physical activity while experiencing or having a history of pain has been shown to go very far in reducing fears associated. We are hopeful that the guidelines will address the need for greater access to providers who are qualified at assessing movement to ensure "better" (perhaps defined as "that which is likely to improve self-efficacy") rather than simply "prescribing" more.

(3) Last, we are hopeful the committee will incorporate language directed at communities, workplaces and operators of large publicly accessible spaces to partner together and with their conservative-care provider community to create multi-stakeholder, interdisciplinary movement coalitions and safe spaces. It is quite clear that the physical, social and cultural environment plays a major role in the physical activity of populations, however the resources for such groups to band together to solve local problems are meager if not lacking entirely. The wide exposure of the guidelines can lend a powerful voice for the organizations and individuals who are pushing for "health-in-all" policies and places including implications on funding and payment for efforts that make it easier to move more or better.

We thank you for your consideration and hope you will contact us with any questions or should the committee consider additional input from our highly qualified and passionate professionals.

Together in Health,

Mike Eisenhart, PT
Founder, Director - The APHPT

Comment ID: 2129

Affiliation: Professional Association

Organization: The Academy of Prevention and Health Promotion Therapies

Topic:
  • Cardiometabolic Health and Weight Management
  • Exposure/Dose Response of Physical Activity
  • Individuals with Chronic Conditions
  • Promotion of Physical Activity (behavior change)

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Anonymous

11/06/2017

We need more high quality Physical Education in schools.

Comment ID: 1129

Affiliation: Educational Institution: Secondary or School System

Organization: Hillsborough

Topic:
  • Youth: ages 6-17

Files Attached: 0

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Patrick Cullen Carroll M Ed CSCS RSCC Emeritus

10/28/2017

Parents should be demanding for more Physical Education not settling for less.

Primum non nocere is a Latin phrase that means "first, do no harm."

Education is about the” whole child.” Physical Education is part of the education process for the “whole child.”

What is physical education (PE)?
PE teaches students how their bodies move and how to perform a variety of physical activities. Students learn the health-related benefits of regular physical activity and the skills to adopt a physically active, healthy lifestyle. The discipline provides learning experiences that meet the developmental needs of students. A standards-based PE program also provides an excellent opportunity to ensure that students develop positive social skills, cooperate with others, and accept responsibility for their own actions.
........................California Department of Education

Research has continually shown the positive correlation between movement and brain development. In my 45 years of involvement in Education, we in Physical Education, have had to constantly fight challenges from academic people to eliminate all or part of Physical Education requirements. In that time I have never seen any attempt by Physical Educators to eliminate all or part of any academic programs.

“Participation” in another program for PE credit is just wrong.
From a letter to California School Districts about the PE Standards from the State Superintendent and State School Board......The Physical Education Model Content Standards for California Public Schools, Kindergarten Through Grade Twelve affirms the standing of physical education; rigor is essential to achievement, and “participation” is not the same as education.

The fact that you don’t have time is not a valid reason to find an easier way to meet students needs in Physical Education. We are is a crisis in this country when we look at fitness levels of students and our entire population. Trying to give PE credit for taking other courses is not the answer.

Research tells us that 70% of children quit sports before high school. One of the benefits of a good Physical Education Program is to give them a positive outlook and experience to remain active for life. In an article in the Riverside Press Enterprise on October 18 this year, it stated that 65% of adults in Riverside are obese. The way we will effectively begin to change this is through Physical Education

Human and Financial Costs of Obesity
* Obesity-related illness, including chronic disease, disability, and death, is estimated to carry an annual cost of $190.2 billion.
* Projections estimate that by 2018, obesity will cost the U.S. 21 percent of our total healthcare costs - $344 billion annually.
* Obesity is also a growing threat to national security – a surprising 27% of young Americans are too overweight to serve in our military. Approximately 15,000 potential recruits fail their physicals every year because they are unfit.
* .....Presidents Council on Fitness, Sport, and Nutrition

Time to do the right thing, not just meet somebody’s Education Agenda.

We can only accomplish this through a Long Term Physical Development Programs. We need more high quality Physical Education in schools.

Comment ID: 1128

Affiliation: Professional Association

Organization: NSCA

Topic:
  • Youth: ages 6-17

Files Attached: 0

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Mike LaMonte Associate Professor

10/27/2017

We ask that the PAGA Advisory Committee please consider adding to the evidence base, this new paper which is In Press at Journal of American Geriatrics Association with an embargo date of no later than November 10 (we are pushing for sooner) which we ask be respected.

The paper reports on a prospective study including more than 6,000 women 63-99 years of age who wore a triaxial accelerometer for up to 7 days and were then followed a median of 3.3 years for mortality as part of the Objective Physical Activity and Cardiovascular Health (OPACH) Study, ancillary to the U.S. Women's Health Initiative program. Accelerometer intensity output was calibrated to measured oxygen uptake during several physical activity tasks germane to older women's lives during a laboratory calibration study. The primary results show a significant inverse linear dose-response (determined by spline regression) between total physical activity and all-cause mortality. Furthermore, both light intensity and MVPA were significantly inversely related with all-cause and CVD mortality, even following mutual adjustment for each intensity. We observed mortality risk reduction associated with light intensity activity in all subgroups studied, including women 80 years and older, whites and blacks, women with functional impairment determined by SPPB physical function testing, and those with 3 or more comorbidities.

We believe these findings, if confirmed, clearly support important health benefits in older women at less than current guideline recommended volume and intensity of physical activity, and support a shifting paradigm to promote "every movement counts" -- including habitual light intensity activity tasks -- for health in an aging society.

Comment ID: 1127

Affiliation: Educational Institution: Higher Education

Organization: University at Buffalo SUNY

Topic:
  • Aging
  • Exposure/Dose Response of Physical Activity
  • Racial/Ethnic Diversity

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Anonymous

10/26/2017

Physical Education should be required daily in all schools and recess should not count as a substitute for PE, it should be a supplement.

Comment ID: 1126

Affiliation: Educational Institution: Secondary or School System

Organization: Hillsborough Township Public Schools

Topic:
  • Youth: ages 6-17

Files Attached: 0

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Jim Parrish PE Teacher and Coach

10/25/2017

Lets create standards and best practices for long term success and enjoyment

• Physical activity guidelines should be linked to LTAD according to the 10 Pillars of LTAD in the NSCA Position Statement on LTAD (https://www.nsca.com/youth_training_and_long-term_athletic…/)
• LTAD and physical literacy are aligned to promote motor skill development and muscular strength development, all of which need to be part of the new guidelines for physical activity.
• Tying sports participation, physical education, and physical activity curriculum and program design across childhood and adolescence (rather than in grade by grade or middle and high school) is imperative to match the nonlinear growth and development patterns of youth.
• Linking sports skill to physical activity guidelines makes the guidelines more kid-centric for many children. Encouraging youth to sample a variety of sports and physical activities compounds their choices and chances for continued engagement in physical activity.
• Health skills fitness AND sport-skills fitness are crucial for the holistic development of youth.
• All kids need a balance of free play, semi-structured play, and structured play in their lives.
• Quality supervision and instruction is critical to holistic child development at all levels and for all ages.

Comment ID: 1125

Affiliation: Educational Institution: Secondary or School System

Organization:

Topic:
  • Youth: ages 6-17

Files Attached: 0

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Anonymous

10/24/2017

The time is now to refine our primary school objectives in physical education, examine our after school program offerings, and build upon this through middle school and high school collectively across this country.
Research tells us that 70% of children quit sports before high school. One of the benefits of a good Physical Education Program is to give them a positive outlook and experience to remain active for life. Physical activity, along with proper nutrition, is beneficial to people of all ages, backgrounds, and abilities. And it is important that everyone gets active: over the last 20 years, there's been a significant increase in obesity in the United States. About one-third of U.S. adults (33.8%) are obese and approximately 17% (or 12.5 million) of children and adolescents (aged 2-19 years) are obese.
The health implications of obesity in America are startling:
* If things remain as they are today, one-third of all children born in the year 2000 or later may suffer from diabetes at some point in their lives, while many others are likely to face chronic health problems such as heart disease, high blood pressure, cancer, diabetes, and asthma.
* Studies indicate that overweight youth may never achieve a healthy weight, and up to 70% of obese teens may become obese adults.
* Even more worrisome, the cumulative effect could be that children born in the year 2000 or later may not outlive their parents.
The impact of obesity doesn't end there. Obesity has personal financial and national economic implications as well. Those who are obese have medical costs that are $1,429 more than those of normal weight on average (roughly 42% higher).
And annual direct costs of childhood obesity are $14.3 billion.
By incorporating physical activity into your daily life—30 minutes for adults and 60 minutes for children—as well as healthy eating, you will experience positive health benefits and be on the path for a better future. It is time to do the right thing, not just meet somebody’s Education Agenda.
We can only accomplish this through a Long Term Physical Development Programs. We need more high quality Physical Education in schools, and certified strength and conditioning professionals working with our physical education and athletic training programs.

Comment ID: 1124

Affiliation: Educational Institution: Secondary or School System

Organization: Hillsborough High School

Topic:
  • Youth: ages 6-17

Files Attached: 0

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Otis Brawley MD

09/01/2017

Please see the attached comments from the American Cancer Society and the American Cancer Society Cancer Action Network. We appreciate the opportunity to provide input to the Committee.

Comment ID: 1123

Affiliation: Other

Organization: American Cancer Society and American Cancer Society Cancer Action Network

Topic:
  • Cancer - Primary Prevention
  • Cardiometabolic Health and Weight Management
  • Exposure/Dose Response of Physical Activity
  • Individuals with Chronic Conditions
  • Promotion of Physical Activity (behavior change)
  • Racial/Ethnic Diversity
  • Sedentary Behavior
  • Youth: ages 6-17

Files Attached: 1

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Dana Wolff Hughes PhD

08/01/2017

Dear Members of the Advisory Committee,

During the physical activity guidelines advisory committee meeting on July 21st, 2017 there was a working group presentation by Kathy Janz focusing on changes in physical activity during the transition from youth to adulthood. This presentation focused on a recent study by Varma et al. (1) which concluded the following: “total physical activity levels in the U.S. at age 19 are comparable to levels at age 60, young adulthood is the only time in the lifespan when physical activity increases, and that males have lower physical activity than females at older adulthood.”

Previous studies using the National Health and Nutrition Examination Survey (NHANES) accelerometer data have not come to the same conclusion, however. Population-referenced total activity counts per day (TAC/d) percentiles constructed by Wolff-Hughes et al. (2, 3) using 2003-2006 NHANES data indicate physical activity levels at age 19 are higher than those at age 60 for both females (250,205 vs. 207,142 TAC/d) and males (346,472 vs. 241,648 TAC/d). An increase in TAC/d during young adulthood was found for females only, with activity levels slightly increasing from age 20 until approximately age 40. Across all ages, TAC was also found to be consistently higher in males than females.

In another study using 2003-2004 NHANES data, Troiano et al. (4) demonstrated that the average accelerometer counts per minute declined with increasing age. For females (F) and males (M), the average counts per minute (cpm) were higher in the 16 – 19-year age group (F:327.8, M:428.9 cpm) compared to the 60 – 69-year age group (F: 251.2, M: 256.7 cpm). The average counts per minute were found to decline with age and were consistently higher for males than females, except in the 60 – 69-year age group, where values were similar.

Sex- and age- specific normative steps/day values for youth and older adults were constructed by Barreira et al. (5) and Tudor-Locke et al. (6) using 2005-2006 accelerometer data. Regardless of sex, participants 19 years of age (F: 6,087, M: 8,510) accumulated substantially more steps/day than those 60 – 64 years of age (F: 4,616, M: 6,209). On average, men were found to accumulate more steps/day than women with age-related declines seen in both the youth and older adult samples.

Despite using varying measures of physical activity and analytical methods, the four studies highlighted have similar conclusions regarding sex and age specific differences in physical activity of United States adults and children. Thus, as the committee moves forward, please consider the entire body of literature when formulating recommendations.

References
1. Varma VR, Dey D, Leroux A, Di J, Urbanek J, Xiao L, et al. Re-evaluating the effect of age on physical activity over the lifespan. Prev Med. 2017; 101:102-8.

2. Wolff-Hughes DL, Fitzhugh EC, Bassett DR, Churilla JR. Waist-worn actigraphy: Population-referenced percentiles for total activity counts in U.S. adults. J Phys Act Health. 2015; 12(4):447-53.

3. Wolff-Hughes DL, Bassett DR, Fitzhugh EC. Population-referenced percentiles for waist-worn accelerometer-derived total activity counts in U.S. youth: 2003 - 2006 NHANES. PloS One. 2014; 9(12):e115915.

4. Troiano RP, Berrigan D, Dodd KW, Mâsse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc. 2008; 40(1):181-8.

5. Barreira TV, Schuna JM Jr, Mire EF, Broyles ST, Katzmarzyk PT, Johnson WD, Tudor-Locke C. Normative steps/day and peak cadence values for united states children and adolescents: National Health and Nutrition Examination Survey 2005-2006. J Pediatr. 2015;166(1):139-43.

6. Tudor-Locke C, Schuna JM Jr, Barreira TV, Mire EF, Broyles ST, Katzmarzyk PT, Johnson WD. Normative steps/day values for older adults: NHANES 2005-2006. J Gerontol A Biol Sci Med Sci. 2013; 68(11):1426-32.

Comment ID: 1122

Affiliation: Federal Agency

Organization: National Institutes of Health

Topic:
  • Aging
  • Miscellaneous
  • Youth: ages 6-17

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David Bassett PhD, Professor and Interim Department Head

07/24/2017

Comment ID: 1121

Affiliation: Educational Institution: Higher Education

Organization: Univ. of Tennessee, Knoxville

Topic:
  • Aging
  • Youth: ages 6-17

Files Attached: 1

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