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Integrating the 2008 Physical Activity Guidelines for Americans and the Guide to Community Preventive Services into Adventure Programs Judy Kruger, PhD.

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Presentation on theme: "Integrating the 2008 Physical Activity Guidelines for Americans and the Guide to Community Preventive Services into Adventure Programs Judy Kruger, PhD."— Presentation transcript:

1 Integrating the 2008 Physical Activity Guidelines for Americans and the Guide to Community Preventive Services into Adventure Programs Judy Kruger, PhD U.S. Centers for Disease Control and Prevention Division of Nutrition and Physical Activity Physical Activity and Health Branch 5 th Annual Research and Evaluation of Adventure Programming (REAP) March 20, 2009 Atlanta, GA

2 Objectives Why evidence-base? Discuss evidence from 2008 Guidelines Identify evidence from the Community Guide Identify potential strategies to include in adventure programs

3 Why evidence-base? Based on what we KNOW…rather than what we THINK works Process of planning, implementing and evaluating programs Individual & community –gain skills/adopt behaviors –improve physical environment

4 What is evidence = proof? Evidence of a health effect Evidence of a program effect Evidence of program design & context SOME action needed SPECIFIC program effect SPECIFIC delivery effect

5 Perceptions Advantages –Lead to efficient use of resources –Continuity & growth of the program –Common performance measures –Supports quality improvement –Helps establish partnership Disadvantages –Need to know where to find evidence –Added expense as tools and process are unfamiliar –Program appears standardized instead of tailored –May impact community buy-in

6 Common components Specific target population Specific, measurable goals Proven benefits Defined program (structure, timeframe, reasoning) Support (staffing skills, facility, equipment)

7 Summary Evidence-based concepts includes: planning, implementing and evaluating Many advantages and disadvantages Multiple evidence-based components to consider

8 Resources CDC, Framework for program evaluation in public health. MMWR (RR-11): CDC, Youth Risk Behavior Surveillance System. CDC, Behavioral Risk Factor Surveillance System. RWJF, Active Living by Design – Case studies.

9 QUIZ Evidence-based research includes the process of planning, implementing and evaluating programs adapted from testing interventions in order to address health issues at the individual and community level? A) True B) False

10 QUIZ Which of the following are perceived advantages of EB? A) Makes it easier to justify funding B) Facilitates spread of program C) Supports continuous quality improvement D) Helps to establish partnership E) All of the above

11 QUIZ Which of the following are common components of EB? A) Specific target population B) Specific, measurable goals C) Proven benefits D) A and B E) All of the above

12 Overview of the 2008 Physical Activity Guidelines for Americans

13 Scientifically established benefits of physical activity (PA) ↓ risk of dying prematurely ↓ risk of dying from heart disease ↓ risk of developing diabetes ↓ risk of developing high blood pressure Helps ↓ blood pressure in people who already have high blood pressure ↓ risk of developing colon cancer ↓ feelings of depression and anxiety Helps control weight Helps build and maintain healthy bones, muscles, and joints Promotes psychological well-being

14 2008 Physical Activity Guidelines for Americans First major review of the science on benefits of physical activity in over a decade Complement previous recommendations Information and guidance on the types and amount of physical activity that provide substantial health benefits

15 Physical Activity Guidelines2005 Dietary Guidelines

16 3 Phases & Products Evidence review (managed by CDC) –Database Advisory committee report (expert panel) –Federal Advisory Report Writing process (appointed panel) –2008 Physical Activity Guidelines for Americans

17 2008 Guidelines strategy CDC triaged 14,472 abstracts CDC reviewed 1,598 papers FACA developed 650 page report HHS writing group created 65 page document Phase IPhase IIPhase III

18 Phase I Evidence Review Literature review examined original research published since January 1995 Health outcome chapters: –All-cause mortality, cardio-respiratory, musculoskeletal, functional health, cancer, mental health, adverse events, metabolic, & energy balance Stratified by age groups –Children and youth (6-18 years) –Adults (19-64 years) –Older adults (65 + years)

19 Initial research questions Is physical activity (PA) associated with the health outcome of interest [x]? What dose of PA is associated with [x]? What level of PA intensity influences [x]? Do different modes (types) influence [x]?

20

21

22 Physical Activity Abstraction Database

23 Evidence table

24 Direct link to pdf

25 Phase II Advisory Committee Report Utilized literature database to develop consensus on PA & health literature Health outcome chapters: –All-cause mortality, cardio-respiratory, musculoskeletal, functional health, cancer, mental health, adverse events, metabolic, & energy balance Additional chapters on understudied populations –Persons with disabilities –Women during pregnancy and the postpartum period –Adults with selected chronic conditions

26 Phase II Advisory Committee William L. Haskell, Stanford University - Chair Miriam Nelson, Tufts University - Vice Chair Rod K. Dishman, University of Georgia Edward T. Howley, University of Tennessee Wendy Kohrt, University of Colorado William Kraus, Duke University I-Min Lee, Harvard University Anne McTiernan, Fred Hutchinson Cancer Center Kenneth E. Powell, Atlanta Georgia Russell R. Pate, University of South Carolina Judy Regensteiner, University of Colorado James Rimmer, University of Illinois, Chicago Antronette Yancey, UCLA

27 Phase II Advisory Committee Reviewed existing scientific literature to identify sufficient evidence to develop a comprehensive set of specific physical activity recommendations

28 Phase III Writing Committee

29 Phase III Writing Process Strong reliance upon Advisory Committee Report Final product - 8 chapters Fact sheet, toolkits, PowerPoint presentation

30 Children and Adolescents (ages 6-17) 1 hour (60 minutes) or more of Aerobic physical activity that is at least moderate: –Most of the 1 or more hours a day should be either moderate- or vigorous-intensity PA –Do vigorous-intensity PA at least 3 days a week Encourage participation in PA that are:  Age appropriate, enjoyable, offer variety

31 Examples of moderate-intensity aerobic activities Children –Brisk walk, hiking –Active recreation (canoeing) Adolescents –Brisk walk, hiking –Active recreation (canoeing) –Yard work such as raking leaves/ bagging leaves –Softball, baseball that require catching and throwing

32 Examples of vigorous-intensity aerobic activities Children –Active games (tag - running and chasing) –Martial arts (karate) –Sports (soccer, hockey, basketball, tennis) Adolescents –Active games (flag football - running and chasing) –Martial arts (karate) –Sports (soccer, hockey, basketball, tennis) –Vigorous dancing

33 Children and Adolescents continued As part of 60 minutes of daily activity to include:  Muscle-strengthening: Include muscle- strengthening physical activity on at least 3 days of the week  Bone-strengthening: Include bone- strengthening physical activity on at least 3 days of the week

34 Examples of muscle strengthening activities Children –Games (tug-of-war) or climbing (ropes or play- ground) –Resistance exercises (body weight or resistance bands) –Ropes, tree climb, swinging on bars/equipment Adolescents –Climbing (pull-ups, push-ups) –Resistance exercises using hand-held weights or weight machines –Swinging on bars/equipment, rope or tree

35 Examples of bone strengthening activities Children –Games (hopscotch) –Jumping rope –Gymnastics, basketball, volleyball Adolescents –Running –Hopping, skipping, jumping –Jumping rope –Gymnastics, basketball, volleyball

36 Youth aerobic physical activity principle Principle = F I T F – Frequency I – Intensity T – Time/Duration 2008 Guideline = minimum F – Daily I – Moderate or Vigorous T – 60 minutes

37 Muscle & bone strengthening principles Muscle strengthening –3 days per week Bone strengthening –3 days per week As part of the daily 60 minutes to include:

38 Key Guidelines – Adults (ages 18 – 64) Minimum aerobic activity for health –2 hours and 30 minutes (150 minutes/week) moderate-intensity aerobic activity; or –1 hour and 15 minutes (75 minutes/week) vigorous-intensity aerobic activity; or –Equal combination for 150 minutes/week Muscle-strengthening activities that involve all major muscle groups should be performed on 2 or more days of the week

39 Key Guidelines – Adults continued For additional health benefits –5 hours (300 minutes) moderate-intensity aerobic activity a week; or –2 hours and 30 minutes (150 minutes) vigorous-intensity aerobic activity a week; or –An equivalent combination (150 minutes)

40 Key Guidelines – Older adults (ages 64+) The key guidelines for adults apply to older adults with additional qualifying guidelines: –Guideline for adults who cannot do 150 minutes/week –Balance exercise –Only use relative intensity to determine the level of effort

41 Adult aerobic physical activity principle Principle = F I T F – Frequency I – Intensity T – Time/Duration 2008 Guideline = minimum F – Weekly I – Moderate or Vigorous T – 150 minutes/week

42 Flexibility in meeting minimal aerobic 2008 Guideline IntensityDuration Frequency Moderate or≥ 150 minutesWeek Vigorous or≥ 75 minutesWeek Equivalent Combination≥ 150 minutes Week

43 Summary Most recent scientific review for Americans in the past decade 2008 Guidelines specify a minimum of aerobic PA based on total time per week For children and adolescents the 2008 Guidelines specify 3 days a week of bone & muscle strengthening activity For adults the 2008 Guidelines specify 2 days a week of muscle-strengthening activity

44 Summary Avoid inactivity –Some activity is better than none Aerobic activity for children & adolescents –≥60 mins/day moderate intensity or equivalent Aerobic activity for adults –Substantial health benefits from medium amounts ≥150 mins/week moderate intensity or equivalent –More health benefits from high amounts ≥ 300 mins/week moderate intensity or equivalent

45 Resources Office of the Surgeon General Healthy Youth for a Healthy Future, HHS Office of the Surgeon General Healthy Youth for a Healthy Future, HHS CDC Division of Adolescent and School Health (DASH), HHS CDC Division of Adolescent and School Health (DASH), HHS CDC DASH Plan to Address Physical Activity, HHS CDC DASH Plan to Address Physical Activity, HHS OWH Powerful Bones. Powerful Girls.™, HHS OWH Powerful Bones. Powerful Girls.™, HHS SmallStep Kids, HHS SmallStep Kids, HHS NIH Ways to Enhance Children's Activity and Nutrition (We Can!), HHS NIH Ways to Enhance Children's Activity and Nutrition (We Can!), HHS Eat Smart. Play Hard.™, USDA Eat Smart. Play Hard.™, USDA

46 QUIZ What is the minimal recommended amount of aerobic physical activity for children and adolescents? A) 30 minutes every day B) 60 minutes every day C) 90 minutes every day

47 QUIZ What is the minimal recommended amount of aerobic physical activity for adults? A) 90 minutes a week B) 120 minutes a week C) 150 minutes a week

48 QUIZ What is the minimal recommended amount of aerobic physical activity for older adults? A) 90 minutes a week B) 120 minutes a week C) 150 minutes a week

49 Overview of the Task Force on Community Preventive Services (TFCP) Recommendations AKA: Community Guide

50 The Community Guide: A Tool for Evidence-Base Independent Task Force on Community Preventive Services Population-based prevention strategies Set of recommendations based on systematic reviews of literature

51 The Community Guide Uses A Systematic Approach Form team Develop conceptual framework Define, group and select interventions to be evaluated Search for and collect evidence of effectiveness Evaluate quality of studies Summarize evidence Consider economics, feasibility, and harms Translate evidence into recommendations

52 Physical Activity Conceptual Framework Interventions Modifiable Determinants Behavioral Outcomes Intermediate Physiological Outcomes Health Outcomes

53 Search strategy 6,238 screened 849 retrieved 253 candidates 94 evaluated

54 What are some strengths of the Community Guide? Systematic review Credible Evidence of effectiveness Sometimes cost effectiveness A good starting point….

55 What are some limitations of the Community Guide Intervention headings arbitrary Limited to available evidence at the time Not the only consideration; not the only evidence Doesn’t account for different contexts, e.g., history, culture

56 Recommendation categories Four possible recommendation categories: Recommended, strong evidence Recommended, sufficient evidence Insufficient evidence Recommended against due to lack of effect, cost, harms

57 5 Recommended strategies Recommended, strong evidence: 1. Community wide campaigns 2. Individually-adapted health behavior change programs 3. School-based physical education 4. Social support interventions in community contexts 5. Creation of/enhanced access to places for PA combined with informational outreach

58 What is the Guide to Community Preventive Services (Community Guide)? Effective population-level strategies to promote physical activity (PA) 3 Intervention categories: –Environmental & policy approaches Creation of/enhanced access to places for PA combined with informational outreach

59 Promoting PA: Environmental and Policy Approaches Multi-component Built environment – access to trails/facilities, creating walking trails, building exercise facilities nearby Reducing barriers (safety, affordability) Training & incentives (site-specific programs, workshops, seminars) The Task Force Strongly Recommended Creation of or enhanced access to places for PA combined with informational outreach

60 Creation of/enhanced access to places for PA combined with informational outreach Community Guide use “places” instead of “facilities” to avoid the implication that physical activity needs a special type of structure. Interventions were not simply about building trails or facilities; many of them also included training, incentives education, risk factor screening or programming to entice and support use of these places for physical activity

61 Results from the Systematic Reviews In all 10 studies reviewed, creating or enhancing access to places for physical activity was effective in getting people to exercise more –Aerobic capacity: median increase of 5.1% (interquartile interval: 2.8% to 9.6%; 8 study arms) –Energy expenditure: median increase of 8.2% (interquartile interval: -2.0% to 24.6%; 3 study arms) –Percentage of participants reporting some leisure-time physical activity: median increase of 2.9% (interquartile interval: -6.0% to 8.5%; 4 study arms) –Exercise score: median increase of 13.7% (interquartile interval: -1.8% to 69.6%; 6 study arms)

62 Results continued Most of the studies also reported weight losses or decreases in body fat among program participants Many of these programs train participants to use exercise equipment, health/fitness programs, and support or buddy systems These interventions were effective among both men and women and in various settings, including industrial plants, universities, federal agencies, and low-income communities If appropriately adapted to the target populations, these interventions should be applicable to diverse settings and groups

63 Resources The Guide to Community Preventive Services: What works to promote health? New York, NY: Oxford Press; 2005: Kahn EB et al., Am J Prev Med. 2002; 22 (4 Suppl): CDC, MMWR, 2001; 50 (RR18) 1-16.

64 QUIZ Which of the following Community Guide recommendations are applicable to adventure programs? A) Creating places to places to be active B) Enhancing access to places to be active C) Informational outreach D) A and B E) All of the above

65 QUIZ The Community Guide recommendation category for the creation or enhanced access to places for physical activity combined with informational outreach activities is? A) Recommended, strong evidence B) Recommended, sufficient evidence C) Insufficient evidence D) Recommended against due to lack of effect, cost, harms E) All of the above

66 Implications Awareness of scientific evidence Individuals need a flexible and adaptable exercise prescription Translation of efforts are needed to encourage inactive to consider becoming active Need to continue monitoring levels of activity in community

67 Wrap up What are some potential strategies to include in adventure programming? What outcomes have you collected that have demonstrated program effectiveness? How have you used these outcomes to leverage funding?

68 For more information Websites:

69 For more information Websites


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