Healthy People 2010¾ Conference Edition

22
Physical Activity and Fitness

Co-Lead Agencies: Centers for Disease Control and Prevention; President’s Council on Physical Fitness and Sports

Contents

Goal

Overview

Issues and Trends

Disparities

Opportunities

Interim Progress Toward Year 2000 Objectives

Healthy People 2010—Summary of Objectives

Healthy People 2010 Objectives

Physical Activity in Adults

Muscular Strength/Endurance and Flexibility

Physical Activity in Children and Adolescents

Access

Related Objectives From Other Focus Areas

Terminology

References

Goal

Improve health, fitness, and quality of life through daily physical activity.

Overview

The 1990s brought a historic new perspective to exercise, fitness, and physical activity by shifting the focus from intensive vigorous exercise to a broader range of health-enhancing physical activities. Research has demonstrated that virtually all individuals will benefit from regular physical activity.¹ The Surgeon General’s Report on Physical Activity and Health concluded that moderate physical activity can reduce substantially the risk of developing or dying from heart disease, diabetes, colon cancer, and high blood pressure.¹ Physical activity also may protect against lower back pain and some forms of cancer (for example, breast cancer), but the evidence is not yet conclusive.^{2, 3}

Issues and Trends

On average, physically active people outlive those who are inactive.^{4, 5, 6, 7, 8} Regular physical activity also helps to maintain the functional independence of older adults and enhances the quality of life for people of all ages.^{9, 10, 11}

The role of physical activity in preventing coronary heart disease (CHD) is of particular importance, given that this disease is the leading cause of death and disability in the United States. Physically inactive people are almost twice as likely to develop CHD as persons who engage in regular physical activity. The risk posed by physical inactivity is almost as high as several well-known risk factors, such as cigarette smoking, high blood pressure, and high blood cholesterol. Physical inactivity, though, is more prevalent than any one of these other risk factors. People with other risk factors for CHD, such as obesity and high blood pressure, may particularly benefit from physical activity.

Regular physical activity is especially important for people who have joint or bone problems and has been shown to improve muscle function, cardiovascular function, and physical performance.¹² However, people with arthritis (20 percent of the adult population) are less active than those without arthritis.¹³ People with osteoporosis, a chronic condition affecting more than 25 million people in the United States, may respond positively to regular physical activity, particularly weight-bearing activities—such as walking¹⁴ and especially when combined with appropriate drug therapy and calcium intake. Increased bone mineral density has been positively associated with aerobic fitness, body composition, and muscular strength.¹⁵

Although vigorous physical activity is recommended for improved cardiorespiratory fitness, increasing evidence suggests that moderate physical activity also can have significant health benefits, including a decreased risk of CHD. For people who are inactive, even small increases in physical activity are associated with measurable health benefits. In addition, moderate physical activity is more readily adopted and maintained than vigorous physical activity.¹⁶ As research continues to illustrate the links between physical activity and selected health outcomes, people will be able to choose physical activity patterns optimally suited to individual preferences, health risks, and physiologic benefits.

For individuals who do not engage in any physical activity during their leisure time, taking the first step toward developing a pattern of regular physical activity is important. Unfortunately, few individuals engage in regular physical activity despite its documented benefits. Only about 11 percent of adults in the United States report regular, vigorous physical activity that involves large muscle groups in dynamic movement for 20 minutes or longer 3 or more days per week. About 23 percent of adults report physical activity for 5 or more days per week for 30 minutes or longer, but another 23 percent do not participate in any regular physical activity.

Public education efforts need to address the specific barriers that inhibit the adoption and maintenance of physical activity by different population groups. Older adults, for example, need information about safe walking routes. Persons with foot problems need to learn about proper foot care and footwear in order to reach appropriate activity levels. People with CHD and other chronic conditions must understand the importance of regular physical activity to maintain function. Each person should recognize that starting out slowly with an activity that is enjoyable and gradually increasing the frequency and duration of the activity is central to the adoption and maintenance of physical activity behavior. Along with the public education efforts, public programs in a variety of settings (recreation centers, worksites, health care settings, and schools) need to be developed, evaluated, and shared as potential models. The availability of group activities in the community is important for many.

Disparities

Disparities in levels of physical activity exist among population groups. The percentage of the population reporting no leisure-time physical activity is higher among women than men, among African Americans and Hispanics than whites, among older adults than younger adults, and among the less affluent than the more affluent. Participation in all types of physical activity declines strikingly as age or grade in school increases. In general, persons with lower levels of education and income are least active in their leisure time. Adults in North Central and Western States tend to be more active than those in the Northeastern and Southern States. People with disabilities and certain health conditions are less likely to engage in moderate or vigorous physical activity than are people without disabilities. Health promotion efforts need to identify barriers to physical activity faced by particular population groups and develop interventions that address these barriers.¹

Data demonstrate that major decreases in vigorous physical activity occur during grades 9 through 12. This decrease is more profound for girls than for boys, whether the measure is engaging in vigorous physical activity in general or in team sports. The President’s Council on Physical Fitness and Sports concluded that because of its physical health and emotional benefits, physical activity has an increasingly important role in the lives of girls.¹⁷ Adolescents’ interest and participation in physical activity differ by gender.¹⁷ Therefore, strategies to increase the amount of physical activity for boys and girls must address these differences and must begin before the disparities in levels of physical activity manifest themselves. Compared to boys, girls are less likely to participate in team sports but more likely to participate in aerobics or dance. Often girls and boys perceive different benefits from physical activity, with boys viewing such activity as competition and girls as weight management. These factors must be considered in developing programs to address the needs of girls. Since boys are more likely than girls to have higher self-esteem and greater physical strength, programs addressing the needs of girls should provide instruction and experiences that increase their confidence and their opportunities to participate in activities, as well as social environments that support involvement in a range of physical activities.¹⁷

Opportunities

The Healthy People 2010 objectives offer opportunities to ensure that physical activity and fitness become part of regular, healthy behavioral patterns. Encouraging any type or amount of physical activity in leisure time can provide important health benefits, compared to a sedentary lifestyle.

Activities that promote strength and flexibility are important because they may protect against disability, enhance functional independence, and encourage regular physical activity participation. These benefits are particularly important for older people—a good quality of life means being functionally independent and being able to perform the activities of daily living.

Young people are at particular risk for becoming sedentary as they grow older. Therefore, encouraging moderate and vigorous physical activity among youth is important. Because children spend most of their time in school, the type and amount of physical activity encouraged in schools are important components.

The major barriers most people face when trying to increase physical activity are time, access to convenient facilities, and safe environments in which to be active. Counseling by primary care providers about the need to participate in physical activity also is an important way to change behavior. In addition, facilities need to be accessible to people with disabilities.

Interim Progress Toward Year 2000 Objectives

Of the 13 physical activity and fitness objectives, 1 has been met—increasing worksite fitness programs. Four objectives show solid gains, indicating that the message about increased physical activity is reaching some segments of the population. The message that sedentary lifestyle plays a role in both overweight and weight loss needs to be addressed better, as does the role primary care providers can play in counseling individuals to increase their daily activities. Both the quantity and quality of school physical education have slipped. Data to evaluate access and availability of community fitness facilities were not available.

Note: Unless otherwise noted, data are from Centers for Disease Control and Prevention, National Center for Health Statistics, Healthy People 2000 Review, 1998-99.

Healthy People 2010—Summary of Objectives

Physical Activity and Fitness

Goal: Improve health, fitness, and quality of life through daily physical
activity.

Healthy People 2010 Objectives

Physical Activity in Adults

22-1. Reduce the proportion of adults who engage in no
leisure-time physical activity.

Target: 20 percent.

Baseline: 40 percent of adults aged 18 years and older engaged in no leisure-time physical activity in 1997 (age adjusted to the year 2000 standard population).

Target setting method: Better than the best.

Data source: National Health Interview Survey (NHIS), CDC, NCHS.

DNA=Data have not been analyzed. DNC=Data are not collected. DSU=Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

22-2. Increase the proportion of adults who engage regularly, preferably daily, in moderate physical activity for at least 30 minutes per day.

Target: 30 percent.

Baseline: 15 percent of adults aged 18 years and older were active for at least 30 minutes 5 or more days per week in 1997 (age adjusted to the year 2000 standard population).

Target setting method: Better than the best.

Data source: National Health Interview Survey (NHIS), CDC, NCHS.

DNA=Data have not been analyzed. DNC=Data are not collected. DSU=Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

*Data for 20 minutes of activity 3 or more days per week are displayed to further characterize the issue.

22-3. Increase the proportion of adults who engage in vigorous physical activity that promotes the development and
maintenance of cardiorespiratory fitness 3 or more days per week for 20 or more minutes per occasion.

Target: 30 percent.

Baseline: 23 percent of adults aged 18 years and older engaged in vigorous physical activity 3 or more days per week for 20 or more minutes per occasion in 1997 (age adjusted to the year 2000 standard population).

Target setting method: Better than the best.

Data source: National Health Interview Survey (NHIS), CDC, NCHS.

DNA=Data have not been analyzed. DNC=Data are not collected. DSU=Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

The adoption and maintenance of regular physical activity represent an important component of any health regime and provide multiple opportunities to improve and maintain health. Because the highest risk of death and disability is found among those who do no regular physical activity, engaging in any amount of physical activity is preferable to none. Physical activity should be encouraged as part of a daily routine. While moderate physical activity for at least 30 minutes is preferable, intermittent physical activity also increases caloric expenditure and may be important for those who cannot fit 30 minutes of sustained activity into their daily schedules. For even greater health benefits, vigorous physical activity is necessary. For most persons, the greatest opportunity for physical activity is
associated with leisure time, because few occupations today provide sufficient vigorous or moderate physical activity to produce health benefits.

Engaging in moderate physical activity for at least 30 minutes per day will help ensure that sufficient calories are used to provide health benefits. A minimum level of intensity (for example, a brisk walk for 30 minutes per day) would, for most persons, result in an energy expenditure of about 600 to 1,100 calories per week.¹⁸ If calorie intake remains constant, this expenditure translates into a weight loss of roughly one-sixth to one-third pound per week. Increases in daily activity to ensure a weekly expenditure of 1,000 calories would have significant individual and public health benefit for CHD prevention and death from all causes, especially for persons who are sedentary. Furthermore, this level of activity is feasible for most persons even though the relative intensity of any activity will vary by age. Starting out slowly and gradually increasing the frequency and duration of physical activity is the key to successful behavior change. In the case of walking, the message becomes, AIf you are not used to daily walking, then walk slowly and take short, frequent walks, gradually increasing distance and speed.@

Muscular Strength/Endurance and Flexibility

22-4. Increase the proportion of adults who perform physical
activities that enhance and maintain muscular strength
and endurance.

Target: 30 percent.

Baseline: 19 percent of adults aged 18 years and older performed physical activities that enhance and maintain strength and endurance 2 or more days per week in 1997 (age adjusted to the year 2000 standard population).

Target setting method: Better than the best.

Data source: National Health Interview Survey (NHIS), CDC, NCHS.

DNA=Data have not been analyzed. DNC=Data are not collected. DSU=Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

22-5. Increase the proportion of adults who perform physical
activities that enhance and maintain flexibility.

Target: 40 percent.

Baseline: 30 percent of adults aged 18 years and older did stretching exercises in the past 2 weeks in 1995 (age adjusted to the year 2000 standard population).

Target setting method: Better than the best.

Data source: National Health Interview Survey (NHIS), CDC, NCHS.

DNA=Data have not been analyzed. DNC=Data are not collected. DSU=Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

All adults could benefit from physical activities designed to ensure functional independence throughout life. The specific physical fitness components that provide continued physical function as persons age include muscular strength/endurance and flexibility. Examples of these activities include weight training, resistance activities (using elastic bands or dumbbells), and stretching exercises (such as static stretching, yoga, or T’ai Chi Chuan).

Effective treatment of many chronic diseases and disorders has resulted in more years of life, but many of these extra years are spent with disabling conditions that prevent independent living and reduce the quality of life. Strengthening activities, while important for all age groups, are particularly important for older adults. Muscle strength declines with age, and there is a demonstrated relationship between muscle strength and physical function.¹⁹ Age-related loss of strength may be lessened by strengthening exercises, enabling an individual to maintain a threshold level of strength necessary to perform basic weight-bearing activities, such as walking.^{20, 21} Strength training also has been shown to preserve bone density in postmenopausal women.²²

Physical activities that improve muscular strength/endurance and flexibility also improve the ability to perform tasks of daily living and may improve balance, thus preventing falls.¹ Activities of daily living have been identified as a scale to measure dependencies in basic self-care and other functions important for independent living and to avoid institutionalization. The performance of routine daily activities is particularly important to maintaining functional independence and social integration in older adults.¹¹

Although flexibility may appear to be a minor component of physical fitness, the consequence of rigid joints affects all aspects of life, including walking, stooping, sitting, avoiding falls, and driving a vehicle. Lack of joint flexibility may adversely affect quality of life and will lead to eventual disability.²³ Activities such as static stretching or T’ai Chi Chuan routines, which consist of slow, graceful movements with low impact, have great promise for maintaining flexibility and can be appropriate for adults of any age.²⁴ Increasing public awareness of all these potential benefits of muscle strengthening and flexibility activities—and developing and making quality programs available and accessible—may encourage the pursuit of activities that promote muscular strength/endurance and flexibility.

Physical Activity in Children and Adolescents

22-6. Increase the proportion of adolescents who engage
in moderate physical activity for at least 30 minutes on
5 or more of the previous 7 days.

Target: 30 percent.

Baseline: 20 percent of students in grades 9 through 12 engaged in moderate physical activity for at least 30 minutes on 5 or more of the previous 7 days in 1997.

Target setting method: Better than the best.

Data source: Youth Risk Behavior Survey (YRBS), CDC, NCCDPHP.

DNA=Data have not been analyzed. DNC=Data are not collected. DSU=Data are statistically unreliable.

*Data for females and males are displayed to further characterize the issue.

22-7. Increase the proportion of adolescents who engage in
vigorous physical activity that promotes cardiorespiratory fitness 3 or more days per week for 20 or more minutes per occasion.

Target: 85 percent.

Baseline: 64 percent of students in grades 9 through 12 engaged in vigorous physical activity 3 or more days per week for 20 or more minutes per occasion in 1997.

Target setting method: Better than the best.

Data source: Youth Risk Behavior Survey (YRBS), CDC, NCCDPHP.

DNA=Data have not been analyzed. DNC=Data are not collected. DSU=Data are statistically unreliable.

*Data for females and males are displayed to further characterize the issue.

22-8. Increase the proportion of the Nation’s public and private schools that require daily physical education for all
students.

Target setting method: 47 percent improvement for middle and junior high schools; 150 percent improvement for senior high schools.

Data source: School Health Policies and Programs Study (SHPPS), CDC, NCCDPHP.

22-9. Increase the proportion of adolescents who participate
in daily school physical education.

Target: 50 percent.

Baseline: 27 percent of students in grades 9 through 12 participated in daily school physical education in 1997.

Target setting method: Better than the best.

Data source: Youth Risk Behavior Survey (YRBS), CDC, NCCDPHP.

DNA=Data have not been analyzed. DNC=Data are not collected. DSU=Data are statistically unreliable.

*Data for females and males are displayed to further characterize the issue.

22-10. Increase the proportion of adolescents who spend at least 50 percent of school physical education class time being physically active.

Target: 50 percent.

Baseline: 32 percent of students in grades 9 through 12 were physically active in physical education class more than 20 minutes 3 to 5 days per week in 1997.

Target setting method: Better than the best.

Data source: Youth Risk Behavior Survey (YRBS), CDC, NCCDPHP.

DNA=Data have not been analyzed. DNC=Data are not collected. DSU=Data are statistically unreliable.

*Data for females and males are displayed to further characterize the issue.

22-11. Increase the proportion of children and adolescents who view television 2 or fewer hours per day.

Target: 75 percent.

Baseline: 60 percent of persons aged 8 to 16 years viewed television 2 or fewer hours per day in 1988-94.

Target setting method: Better than the best.

Data sources: National Health and Nutrition Examination Survey (NHANES), CDC, NCHS; after 2000, Youth Risk Behavior Survey (YRBS), CDC, NCCDPHP.

DNA=Data have not been analyzed. DNC=Data are not collected. DSU=Data are statistically unreliable.

The health benefits of moderate and vigorous physical activity are not limited to adults. Physical activity among children and adolescents is important because of the related health benefits (cardiorespiratory function, blood pressure control, and weight management) and because a physically active lifestyle adopted early in life may continue into adulthood. Even among children aged 3 to 4 years, those who were less active tended to remain less active than most of their peers after age 3 years.²⁵ These findings highlight the need for parents, educators, and health care providers to become positive role models and to be involved actively in the promotion of physical activity and fitness in children and adolescents.

Many children are less physically active than recommended, and physical activity declines during adolescence.^{26, 27} One study found that one-quarter of U.S. children spend 4 hours or more watching television daily.²⁸ Schools are an efficient vehicle for providing physical activity and fitness instruction because they reach most children and adolescents. Participation in school physical education ensures a minimum amount of physical activity and provides a forum to teach physical activity strategies and activities that can be continued into adulthood. Findings suggest that the quantity and, in particular, the quality of school physical education programs have a significant positive effect on the health-related fitness of children and adolescents by increasing their participation in moderate to vigorous
activities.^{29, 30}

Studies have shown that spending 50 percent of physical education class time on physical activity is an ambitious but feasible target. Being active for at least half of physical education class time on at least half of the school days would provide a substantial portion of the physical activity time recommended for adolescents.³¹ To achieve the benefits of school-based physical education equitably for all children, daily adaptive physical education programs should be available for children with special needs. School physical education requirements also are recommended for students in preschool and postsecondary programs.³²

Physical education is the primary source of physical activity and fitness instruction. Health education and other courses, however, can highlight the importance of physical activity as a component of a healthy lifestyle. A well-designed health education curriculum can help students develop the knowledge, attitudes, behavioral skills, and confidence needed to adopt and maintain physically active lifestyles.³² To maximize classroom time, instruction on physical activity also can be integrated into the lesson plans of other school subjects, such as mathematics, biology, and language arts. Programs that have included classroom instruction in physical activity have been effective in enhancing students’ physical activity-related knowledge,³³ attitudes,³⁴ behavior,³⁵ and physical fitness.³⁶ (See Focus Area 7. Educational and Community-based Programs.)

Access

22-12. (Developmental) Increase the proportion of the Nation’s public and private schools that provide access to their physical activity spaces and facilities for all persons
outside of normal school hours (that is, before and after the school day, on weekends, and during summer and other vacations).

Potential data source: School Health Policies and Programs Study (SHPPS), CDC, NCCDPHP.

22-13. Increase the proportion of worksites offering employer-sponsored physical activity and fitness programs.

Target: 75 percent.

Baseline: In 1998-99: