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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

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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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Saibal Mitra

06/30/2017

To get to the desired goal where the vast majority of the population is exercising at an appropriate level, requires children learning to do this in school. Just consider what would happen if schools didn't exist and we would just give guidelines to parents on the importance on following courses on reading, writing math etc. for them and their children. We know that we can't come close to educational goals when it comes to math and literacy without school, so it's no surprise that we have an unfit population because physical fitness is not actively taught in school.

The difference between teaching a subject like math and physical exercise, is that the latter cannot be done during school hours alone. The child needs to exercise in his/her free time. At school the teachers can teach children how to do certain exercises in proper form, tests such as the Cooper test can be done to keep track of the fitness status of each child, and homework can be given that's specific for each child. When a child's progress falls behind of a reasonable schedule then the teachers can discuss that with the parents. There may be certain illnesses at play, or the diet of the child may not be ideal, or the child is not sticking to the fitness homework given by the teachers.

Physical education taught this way will lead to adults who will be much fitter on average than today's adults, but they'll also value their fitness more, they'll be far more inclined to keep on exercising throughout their lives. Also, the fact that they start out with a better fitness will make it a lot easier for them to keep on exercising.

But implementing such a program is going to require some investments, where would the money come from? Here one can consider the enormous healthcare savings of a successful program. So, it shouldn't be difficult for schools to be given subsidies for implementing a physical education program as outlined above, the children educated at the school will end up claiming far less money from their health insurance plans in later life. Common diseases that like heart disease and certain cancers that have a strong link to to sedentary lifestyles are also very expensive to treat.

An educational program as outlined above is going to yield results a decade down the line, but there are other measures one can take that target adults that can have results on a shorter term. Health insurance companies can save a lot of money of their customers stick to an exercise program. Obese people who succeed in losing weight will save their health insures a lot of money too. This means that it is profitable for health insurance companies to offer discounts on the premium of people who verifiably stick to certain health programs. Such discounts can be enough of an incentive to get people started to exercise or lose weight. This will require changes in the healthcare law.

Political support for allowing discounts in premium to be given should be easy to obtain, as patients with chronic conditions such as diabetes or obesity will benefit the most here. It's easy to verify if a diabetic is sticking to blood sugar control measures, or if an obese person is losing weight. In contrast, it's not so easy to come up with fraud proof methods to verify if a healthy person is sticking to some exercise plan.

Comment ID: 1120

Affiliation: Individual/Professional

Organization:

Topic:
  • Cardiometabolic Health and Weight Management
  • Exposure/Dose Response of Physical Activity
  • Sedentary Behavior
  • Youth: ages 3-6
  • Youth: ages 6-17

Files Attached: 0

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Charles Corbin Professor Emeritus, PhD

06/19/2017

I have submitted comments previously. However, I recently read this article that I think is of relevance to the 2018 guidelines. Thompson, D. et al., Feedback from physical activity monitors......Preventive Medicine 91, 389-394, 2016. If current 150 minute per week MVPA standard is in addition to accumulated normal daily activity the wide use of activity monitors by the general public may lead to false ideas about achieving PA standards. 2018 guidelines will need to clarify this.
CBC

Comment ID: 1119

Affiliation: Educational Institution: Higher Education

Organization: Arizona State University

Topic:
  • Miscellaneous

Files Attached: 0

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Anonymous

05/22/2017

Dear Physical Activity Guidelines Committee,

I've noticed that obesity rates in our country appear to be climbing, even as the number of adults reaching the recommended physical activity guidelines/ leisure time physical activity guidelines is improving. Perhaps we need public health surveillance data reporting to reconcile this disheartening discrepancy?

Also, given that the majority of physical activity measurement methods have relied upon self-reported physical activity, how do we know the current guidelines are sufficient?

Perhaps we should revisit the physical activity recommendations (minutes per week, etc) now that we have better tools to measure physical activity with (for example, heart rate monitors) and the prices of such technology is falling.

Specially, I am looking for small area data, as I write here:
https://medium.com/lori-suzanne/opinion-data-on-physical-activity-is-missing-in-action-from-public-health-surveillance-ffbceb0cd7da

I believe better data, more robust on physical activity, could help public health practitioners advocate for increased investment in physical activity promotion / interventions.


Thank you!
Lori

Comment ID: 1117

Affiliation: Individual/Professional

Organization: Student, Mailman School of Public Health, Columbia University

Topic:
  • Exposure/Dose Response of Physical Activity
  • Miscellaneous
  • Promotion of Physical Activity (behavior change)

Files Attached: 2

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PHILIP HABERSTRO BS

05/08/2017

Believe it is important to measure SOCIAL CAPITAL in the organizations and communities where we are working to create organizational/community cultures that promote physically active life styles . Civic health is essential to fostering the processes that facilitate change - Research (see Robert Putnam's book Bowling Alone) has demonstrated that communities with higher levels of SOCIAL CAPITAL are healthier - We have made good progress on demonstrating the role of the environment , the economic and health benefits of regular physical activity to the individual and society . Adding the SOCIAL CAPITAL metric would strengthen and help us sustain the comprehensive approach necessary to create a healthy US population ... PHIL

Comment ID: 1116

Affiliation: Individual/Professional

Organization: www.CreatingHealthyCommunities.org

Topic:
  • Aging
  • Cardiometabolic Health and Weight Management
  • Exposure/Dose Response of Physical Activity
  • Promotion of Physical Activity (behavior change)
  • Racial/Ethnic Diversity
  • Youth: ages 6-17

Files Attached: 0

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Heather Tritsarolis COTA

04/25/2017

Comment ID: 1115

Affiliation: Individual/Professional

Organization: Jefferson College of Health Sciences

Topic:
  • Aging
  • Miscellaneous
  • Promotion of Physical Activity (behavior change)
  • Sedentary Behavior

Files Attached: 1

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Rachel Boitnott PTA

04/25/2017

April 25, 2017
2018 Physical Activity Guidelines Advisory Committee

Dear Members of the Advisory Committee,
As a student studying Health and Exercise Science, I am looking forward to the 2018 Physical Activity Guidelines and the positive effect they will hopefully have on our nation’s health. There are several areas I think the new guidelines should address, including public education about the physical activity guidelines and the dangers of sedentary behaviors, education on the older adult physical activity guidelines, and definitions of moderate and vigorous physical activity.
First of all, I think we need to do a better job of getting the word out about the guidelines. Before I began studying Health and Exercise Science, I was unaware there were physical activity guidelines. Most people I encounter through work, school, or my personal life are also unaware there are official guidelines. A 2009 cross-sectional analysis of 4,281 American adults showed that 36.1% knew there was some type of government recommended level of physical activity, but less than 1% were aware of the moderate to vigorous intensity physical activity recommendations (Kay, Carroll, Carlson, & Fulton, 2014). Clearly, the public is lacking in education on the guidelines and cannot be expected to participate in the recommended amount of physical activity if they are unaware of those recommendations. An opportunity is available to the committee as the 2018 guidelines come out to spread the word to the American public about physical activity recommendations. This could be done in many ways, including mass media campaigns. Health professionals such as physicians, nurses, and physical and occupational therapists also need to be involved in educating their patients on the guidelines and the dangers of a sedentary lifestyle.
Secondly, the older adult population in particular is at risk for sedentary behaviors. I work with older adults as a Physical Therapist Assistant. Most of my patients do not realize they need to be physically active and some actually believe being sedentary is better for their health. Educating people of all ages on the older adult physical activity guidelines is important so that family members and caregivers can encourage their grandparents/older adults in their life to be physically active. I think that once again, mass media campaigns and the involvement of healthcare workers need to be utilized in spreading the word on the older adult physical activity guidelines.
Finally, I believe there needs to be a definition of what constitutes moderate and vigorous physical activity. This is something I and my Health and Exercise Science classmates struggled to understand and define. In my work as a Physical Therapist Assistant, and many of my patients do not realize there is a difference between being active during the day (ie: caring for a grandchild) and physical activity. While there is a benefit to being active during the day, as opposed to being sedentary, having a simple and easy to understand definition of moderate and vigorous intensity physical activity would help people differentiate between being active and participating in actual physical activity.
Thank you for allowing me and the rest of the public to share our thoughts, opinions, and concerns on the physical activity guidelines and how they affect us personally and nationally.

Rachel B.
Physical Therapist Assistant
Health and Exercise Science Student
Virginia

Kay, M., Carroll, D., Carlson, S., & Fulton, J. (2014). Awareness and Knowledge of the 2008 Physical Activity Guidelines for Americans. Journal Of Physical Activity And Health, 11(4), 693-698. http://dx.doi.org/10.1123/jpah.2012-0171

Comment ID: 1114

Affiliation: Individual/Professional

Organization: Jefferson College of Health Sciences

Topic:
  • Aging
  • Promotion of Physical Activity (behavior change)
  • Sedentary Behavior

Files Attached: 0

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Jordan Hughes

04/25/2017

April 24,2017
2018 Physical Activity Guidelines Advisory Committee

Dear Members of the Committee:

I look forward to seeing what’s included in the 2018 physical activity guidelines and hope that they help people realize the benefits of living an active lifestyle. There are several things I would like to address in my comment to the committee. The first thing I would like to mention is the growing amount of mental health issues and number of people affected. Common mental health issues that many struggle with are anxiety, depression, dementia, schizophrenia, substance abuse and substance dependence. Every year about 42.5 million American adults suffer from serious mental illness, and according to the New World Health Organization, the number of people living with depression has increased by 18% from 2005 to 2015 (http://www.who.int/mental_health/en/). This could mean that many are either leaving problems untreated, or perhaps worse, because treatments are costly, they may “self-diagnose”, thinking they have recovered and then stop taking their medications or cease their talk therapy, which normally causes a relapse. By addressing these issues and pointing out the benefits physical activity with persons with mental health disorders, we can help combat some of these ever increasing mental problems.
Physical activity has been shown to help reduces the risk of depression and cognitive decline in adults and the elderly. Participating in regular physical activity and exercise can lower the risk for depression, distress and lack of well-being and dementia by 20-30%, which could in turn help with the cost of healthcare. Physical activity among youth and adults have proven to show improvements in reaction time, learning and intelligence scores, and cognitive function, all of which are related to the brain and how efficiently it works.
The 2008 guidelines for physical activity suggest 3 to 5 days a week for 30 to 60 minutes each day. However, for someone suffering severe depression or anxiety, they often cannot even get out of bed on most days, much less find the will to do any type of physical activity. I would suggest a more realistic goal of 5 or 10 minute sessions throughout the day. It would be somewhat beneficial physically and not overwhelming to those just beginning their healthy journey (Mental Health Benefits of Exercise). A study in the UK even found that people who squeeze their exercise routines into one or two longer sessions on the weekends have almost as many health benefits as those who work out more often (Student Wellness Services).
Exercise is a natural and very effective anti-anxiety treatment; the more you attempt the better you will feel both mentally and physically. Exercise relieves tension, stress, boosts physical and mental energy and enhances well-being through the release of endorphins. Endorphins elicit similar effect to that of morphine, for example, the “runner’s high” is the euphoric feeling you get after a run or workout which can be accompanied by a positive and energizing outlook on life.
Lastly, I would like to urge you to reach out to all public health professionals such as doctors, nurses, physician assistants and in particular psychiatrists and psychologists. Encourage them to become familiar with these new guidelines and inform their patients of the benefits of physical activity and what advantages it provides in regard to mental health. Furthermore, due to the accessibility of technology (smartphones, tablets, computers, television, etc.), I believe that the entire nation has become sedentary. We need to concentrate on getting people motivated to be healthy and become more physically active. I believe the first step is educating our patients and motivating health care professionals to recommend more physical activity into patient care instead of only prescribing medications.
Thank you for this opportunity to share some of my thoughts and concerns of mental health and physical activity. I look forward to reading the new guidelines released in 2018 and new research on the horizon.



Jordan Hughes, Student
Health and Exercise Science
Jefferson College of Health Science






References

Student Wellness Services. (n.d.). Retrieved March 28, 2017, from http://www.queensu.ca/studentwellness/health-promotion/health-resources/physical-activity

Mental Health. (n.d.). Retrieved March 27, 2017, from http://www.who.int/mental_health/en/
The Mental Health Benefits of Exercise. (n.d.). Retrieved March 27, 2017, from https://www.helpguide.org/articles/exercise-fitness/emotional-benefits-of-exercise.htm

Comment ID: 1113

Affiliation: Individual/Professional

Organization: Jefferson College of Health Science

Topic:
  • Brain Health (mental health, cognition, etc.)

Files Attached: 0

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