1. Promoting Physical Activity to REAL People: Practical Considerations and Concerns T.K. Behrens Ph.D., CHES, FACSM Health Promotion Laboratory, University of Colorado at Colorado Springs

2. Good Morning!

3. What is Physical Activity? Physical Activity – “…any bodily movement that results in energy expenditure” Occupation Transportation Leisure-time Activities of daily living (i.e., housework, etc.) Exercise – Physical activity using large muscle groups that is planned, structured, repetitive, and purposive Casperson, 1985

4. Current PA Recommendation “Adults should do at least 150 minutes (2 hours and 30 minutes) a week of moderate-intensity, or 75 minutes (1 hour and 15 minutes) a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity.” “For additional and more extensive health benefits… increase aerobic physical activity to 300 minutes (5 hours) a week of moderate-intensity, or 150 minutes a week of vigorous-intensity aerobic physical activity… Additional health benefits are gained by engaging in physical activity beyond this amount. “ http://www.health.gov/paguidelines/guidelines/chapter4.aspx

5. Are we Doing it?

6. Physical Activity in U.S. Adults CDC, 2007

7. www.cdc.gov/diabetes Age-adjusted percent County-level Estimates of Leisure-time Physical Inactivity among Adults aged ≥ 20 years: United States 2006

8. www.cdc.gov/diabetes Age-adjusted percent County-level Estimates of Leisure-time Physical Inactivity among Adults aged ≥ 20 years: United States 2007

9. www.cdc.gov/diabetes Age-adjusted percent County-level Estimates of Leisure-time Physical Inactivity among Adults aged ≥ 20 years: United States 2008

10. 2006 Age-Adjusted Estimates of the Percentage of Adults † Who Are Physically Inactive in New Hampshire

11. 2007 Age-Adjusted Estimates of the Percentage of Adults † Who Are Physically Inactive in New Hampshire

12. 2008 Age-Adjusted Estimates of the Percentage of Adults † Who Are Physically Inactive in New Hampshire

13. The Burden of Physical Inactivity The Outcome – Obesity, CVD, cancer, diabetes – Physical inactivity is a primary factor in over 200,000 deaths annually – 2 million deaths worldwide Small increases could affect 30K to 35K deaths/yr Medical costs exceed $76 billion annually – Comparable to tobacco costs

14. Why Aren’t We Doing It?

15. Which one is better for my unborn child?

16. Cultural Values?

17. NY Times, 2008 Technology?

18. Environmental Design?

19. No Time?

20. Current Time Trends

21. What Can WE Do to Encourage Physical Activity?

22. Be Grounded in Behavior Change Theory ! Social Ecological Model Transtheoretical Model

23. Be Knowledgeable of Best Practices! The Guide to Community Preventive Services (the Community Guide) www.thecommunityguide.org www.thecommunityguide.org Recommended: – Individually-adapted health behavior change programs Individually-adapted health behavior change programs – Social support interventions in community settings Social support interventions in community settings – Enhanced school-based physical education Enhanced school-based physical education – Community-wide campaigns Community-wide campaigns – Community-scale urban design and land use policies Community-scale urban design and land use policies – Creation of or enhanced access to places for physical activity combined with informational outreach activities Creation of or enhanced access to places for physical activity combined with informational outreach activities – Street-scale urban design and land use policies Street-scale urban design and land use policies – Point-of-decision prompts to encourage use of stairs Point-of-decision prompts to encourage use of stairs

24. Translation…

25. Incentives Behavioral economics? Typically results in higher HRA participation rates for worksites if ~$100 is offered Careful of behavior tied to incentive May not translate to long-term behavior change Goetzel & Ozminkowski, 2008

26. Technology

27. Has been demonstrated to increase EE over sedentary activities in children Insufficient evidence otherwise Promising avenue? Lanningham-Foster, 2009

28. Transportation

29. Transit Ridership and Percent ‘Active Walkers’

30. Active Transportation and Obesity Rates Bassett et al., 2010

31. Negative Impacts of Suburbia Suburbs Less Walking More driving More energy consumption More pavement More built space Less exercise More pollution Less green space Worse health

32. Most transportation experts agree this road is poorly designed Poorly Designed Street Networks Completestreets.org

33. Most transportation experts agree this road is better designed Designed for Multiple Uses Completestreets.org

34. Sport Godbey & Robinson, 1999 Americans’ Use of Time Project

35. Guerilla Marketing Fitness First Bus Scale “Corn Maze”

37. Take a Walk in Zion: Preliminary Results Media message content Environmental/ climate factors Bus specific differences Target audience Community involvement Trail specific features Non-pedestrian factors Trail access Resistance to protocol Suggestions for improvement Behrens et al., APHA 2008

38. Sedentary to Active Time Park far away Take stair instead of elevators Skip the stop Stepping commercials Play with children More?

39. A N.E.A.T. Idea Dr. James Levine Mayo Clinic Rochester, MN Speed = 0. 7 mph

40. Your Ideas? Does it address multiple levels of influence? Does it address readiness to change? Does it hold a relative advantage over its predecessors? What is the complexity level? Is the program trialable? Is it convenient? Are the results observable? What is the time investment?

41. There’s nothing new under the …

42. Physical Activity Recommendation, 1786 A horse gives but a kind of half exercise, and a carriage is no better than a cradle. I sometimes wonder whether we have not lost more than we gained by the use of this animal. No one has occasioned so much the degeneracy of the human body. Not less than two hours a day should be devoted to exercise, and the weather should be little regarded. -Thomas Jefferson

43. Henry David Thoreau, 1862 “I think that I cannot preserve my health and spirits unless I spend 4 hours a day… sauntering through the woods and over the hills and fields, absolutely free from all worldly engagements….” “ I confess that I am astonished at the endurance, to say nothing of the moral sensibility of my neighbors who confine themselves to offices the whole day for weeks and months, aye, and years almost together. I know not what stuff they are [made] of.”

44. Take Home Message (What to tell your family and friends) Some Physical Activity Is Better Than None Additional Health Benefits With More Physical Activity Additional Benefits With Vigorous Physical Activity Accumulation of Physical Activity

45. Tips for Being More Active There are 1440 minutes in every day... Schedule 30 of them for PA Walk, cycle, jog, skate, etc., to work, school, the store, or place of worship. Park the car farther away from your destination, or get on or off the bus several blocks away. Take the stairs instead of the elevator or escalator. Play with children or pets. Perform gardening or home repair activities. Avoid labor-saving devices-turn off the self-propel option on your lawn mower or vacuum cleaner. Use leg power-take small trips on foot to get your body moving. Exercise while watching TV (for example, use hand weights, stationary bicycle/treadmill/stairclimber, or stretch). Dance to music. Keep a pair of comfortable walking or running shoes in your car and office. You'll be ready for activity wherever you go! www.cdc.gov

46. Tips for People Who Have Been Inactive for a While Use a sensible approach by starting out slowly. Begin by choosing moderate-intensity activities you enjoy the most. By choosing activities you enjoy, you'll be more likely to stick with them. Gradually build up the time spent doing the activity by adding a few minutes every few days or so until you can comfortably perform a minimum recommended amount of activity (30 minutes per day). As the minimum amount becomes easier, gradually increase either the length of time performing an activity or increase the intensity of the activity, or both. Vary your activities, both for interest and to broaden the range of benefits. Explore new physical activities. Reward and acknowledge your efforts. www.cdc.gov

47. Questions? For more information please contact Tim Behrens tbehrens@uccs.edu