Presentation on theme: "Epidemiology of Physical Activity: 101 July 17, 2007 Steven H"— Presentation transcript:
1 Epidemiology of Physical Activity: 101 July 17, 2007 Steven H Epidemiology of Physical Activity: 101 July 17, Steven H. Kelder, PhD, MPH Professor, Division of Epidemiology Co-Director, Michael & Susan Dell Center for Advancement of Healthy Living
2 The DilemmaMost Americans are not physically active enough to achieve substantial health benefitRelated disease outcomes are very costlyWith adults, traditional PA promotion efforts have had limited effectSustaining higher activity levels will require a comprehensive approachI would summarize our current dilemma this way:most of us are not physically active enough to achieve a substantial health benefitthe human and financial burden from diseases related to physical inactivity is hugetraditional efforts to promote physical activity have generally been limited to individual behavior change approaches, neglecting the role of the built environmentcomprehensive strategies to promote Active Living through community design must be an key piece of the puzzle
3 The World According to Steve Start young – school based programs work. Children can be found at school. Young parents, preschool.Physical activity quickly declines as students enter middle school and high school (especially girls).Promote calcium consumption and weight bearing physical activities to women and girls.Reinforce school lessons at home and in the community.Promote use of community parks and recreation.Create social events; eating and PA are social behaviors.Where: worksites, point of purchase, church, schoolStay in it for the long haul.
4 What Do We Mean by Food and Physical Activity Environments What Do We Mean by Food and Physical Activity Environments? (from macro to micro)Physical and economic environments: food product (including packaging, portion size), price, promotion, placement – access, availability, affordability, convenience, parks and recreationInformation environments: media, marketing, public education (including point of purchase information, food labels)Social environments: social and cultural norms/practices, role models; health provider and other social support for health behavior changeBehavioral settings: schools, homes, neighborhoods, communities, youth-serving organizations, child care centers, grocery and convenience stores, restaurants/fast food outlets, vending machines, worksitesAlthough genetic and biological factors are important at the individual level, and help to explain why some of us seem better able to resist weight gain in an increasingly toxic environment, the rapidity with which obesity has spread can only be explained by sweeping changes in the environment that have modified both caloric intake and energy expenditure.
5 The (possible) causesMass media saturated with unhealthy messages and advertisingProliferation of easily available low nutrient, calorie dense foodsIncreasing frequency of restaurant eating and larger portion sizes (Super Size Me!)
6 The (possible) causesIncreasing amount of time spent indoors with mass media and gamesIncreased car travel and less person-powered transportIncreased concerns over child safety - stranger danger and trafficFewer walkable destinations - shops, grocery, post office
7 The (possible) causesMore families with two working parents “Go inside and lock the door until we get home”Parents working longer hours - too tired and too busy to playPersonal injury litigation and reduced opportunities for physical activityPoor fundamental movement skills - as children participate less, they fail to develop these fundamental skills so want to participate less
8 The (possible) causesSchools increasingly reluctant to devote time to health educationPoor fundamental movement skills - as children participate less, they fail to develop these fundamental skills so want to participate less
13 Increased Life Expectancy Increased years due topublic health measures:25Increased years due tomedical care advances:5Source: Centers for Disease Control and Prevention (CDC).
14 Causes of Death in United States – 2002 Actual Causes of Death2Leading Causes of Death1Heart DiseaseTobaccoCancerPoor diet/ lack of exercise3StrokeAlcoholChronic lower respiratory diseaseInfectious agentsUnintentional InjuriesPollutants/toxinsDiabetesFirearmsPneumonia/influenzaSexual behaviorAlzheimer’s diseaseMotor vehiclesKidney DiseaseIllicit drug usePercentage (of all deaths)Percentage (of all deaths)Sources: 1 National Vital Statistics Reports, Vol. 53, No. 15, February 28, 2005.2 Adapted from McGinnis Foege, updated by Mokdad et. al., 2000.3 JAMA, April 20, 2005—Vol 293, No. 15, pg 1861.
15 Physical Activity and Fitness Benefits Builds and maintains healthy bones and muscles, controls weight, builds lean muscle, reduces fat, reduces blood pressure, and improves blood glucose controlDecreases the risk of obesity and chronic diseases (CHD, high blood pressure, diabetes, colon cancer, and osteoporosis)Reduces feelings of depression and anxiety and promotes psychological well-beingRelated to functional independence of older adults and quality of life of people of all ages
16 Physical Activity Improves Lives A physically active Texas population would expect to see: 30 % fewer cases of heart disease, stroke, colon cancer, and osteoporosis18 % fewer cases of type 2 diabetes and hypertension16 % fewer injuries from falls in the elderly12 % fewer cases of depression and anxiety5 % fewer cases of breast cancerPA helps the elderly maintain their independence longer.PA results in more productive employees by decreasing illness and absenteeism.
17 Sedentary Behavior is a Natural Response to our Environment Our culture increasingly values cars, television, computers, and convenience, making physical activity less a natural part of our lives.Newer communities are often designed without sidewalks or streetlights, decreasing walkability.Communities are designed with housing far from schools, shopping, or other activities, making walking or biking for transportation infeasible.Increasing traffic congestion and aggressive driving hampers the walkability of neighborhoods.More and more employees have sedentary jobs decreasing the amount of activity incurred during daily routines.Children are taking fewer physical education classes in school.
18 Activity can be EasyAchieving the recommended amount of physical activity is as simple as taking three ten-minute walks per day.Health benefits occur even with very modest increases in activity, even if the recommendation is not met.The largest benefits occur to those who were previously completely sedentary.Any incremental physical activity is beneficial to health.Vigorous exercise is very beneficial to health, but a brisk walk is beneficial as well.Little changes, such as parking farther away from the store or opting for the stairs instead of the elevator, go a long way toward promoting health and preventing disease.
19 Dietary Guidelines for Americans Aim for FitnessAim for a healthy weightBe physically active each dayBuild a Healthy BaseLet the Pyramid guide your food choicesChoose a variety of grains daily, especially whole grainsChoose a variety of fruits and vegetables dailyKeep food safe to eat
20 Dietary Guidelines for Americans Choose SensiblyChoose a diet that is low in saturated fat and cholesterol and moderate in total fatChoose beverages and foods to moderate your intake of sugarsChoose and prepare foods with less saltIf you drink alcoholic beverages, do so in moderation
21 Vegetables and Fruits5 or more servings of vegetables and fruits each dayResearch suggests this one dietary change could prevent as many as 20% of all cancersVegetables and fruits provide vitamins, minerals, and phytochemicalsVariety is important to get the widest array – dark green, deep orange, citrus
22 Other Plant-based Foods 7 or more servings of other plant-based foods such as whole grains and legumesWhole grains are higher in fiber, vitamins, minerals, and phytochemicals than refined grains
23 The New American Plate2/3 or more of the plate should be covered by plant-based foods – vegetables, fruits, whole grains, and beans – 1 or more vegetables or fruits and not just grain products1/3 or less of the plate should be covered by meat, fish, poultry, or low-fat dairy
24 Physical ActivityEngage in regular physical activity and reduce sedentary activities to promote health, psychological well-being, and a healthy body weight.Achieve physical fitness by including cardiovascular conditioning, stretching, and resistance exercises.Children and adolescents – At least 60 minutes on most, preferably all, days of the week.
25 New for 2005 Specificity of recommendations At least 30 minutes to reduce risk of chronic diseaseUp to 60 minutes of moderate to vigorous physical activity may be needed to prevent gradual weight gain that occurs over time60 to 90 minutes of moderate-intensity physical activity to sustain weight lossRecommendations for specific populationsThose who need to lose weight, overweight children, pregnant women, breastfeeding women, overweight adults and overweight children with chronic diseases and/or on medication
27 U.S. Obesity and Diabetes Trends in The data shown in these maps were collected through CDC’s Behavioral Risk Factor Surveillance System (BRFSS).Source: Mokdad AH, Serdula MK, Dietz WH, et al.JAMA, October 27, 1999; 282(16):
28 Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)No Data <10% %–14%
29 Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)No Data <10% %–14%
30 Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)No Data <10% %–14% %–19%
31 Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)No Data <10% %–14% %–19% ≥20
32 Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative.About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980.No Data <10% %–14% %–19% %–24% ≥25%
33 Diabetes Trends. Among Adults in the U. S Diabetes Trends* Among Adults in the U.S., (Includes Gestational Diabetes) BRFSS 1990No Data <10% %–14% %–19% %–24% ≥25%Source: Mokdad et al., Diabetes Care 2000;23:
34 Diabetes Trends. Among Adults in the U. S Diabetes Trends* Among Adults in the U.S., (Includes Gestational Diabetes) BRFSS 1995No Data <10% %–14% %–19% %–24% ≥25%Source: Mokdad et al., Diabetes Care 2000;23:
35 Diabetes Trends. Among Adults in the U. S Diabetes Trends* Among Adults in the U.S., (Includes Gestational Diabetes) BRFSS 2000No Data <10% %–14% %–19% %–24% ≥25%Source: Mokdad et al., J Am Med Assoc 2001;286:10.
36 Diabetes Trends. Among Adults in the U. S Diabetes Trends* Among Adults in the U.S., (Includes Gestational Diabetes) BRFSS 2001No Data <10% %–14% %–19% %–24% ≥25%Source: Mokdad et al., J Am Med Assoc 2001;286:10.
37 Source: Ogden et al., JAMA, 2006 Prevalence of Obesity* in Adults by Gender and Race*BMI > 30NHANESThese are the most recent prevalence figures we have on overweight in adults broken down by gender and race.Note that these figures include both “overweight” and “obese” individuals together (BMI > 25).Females tend to be heavier, especially minority females.These data are from NHANES III, in which these people were actually weighed and measured for height.Note that African American and Hispanic females are approximately 50% overweight.Source: Ogden et al., JAMA, 2006
38 Most Recent NHANES Results 66.3% of American adults are overweight (BMI ≥ 25)4.8% of American adults are extremely obese (BMI ≥ 40)10.5% of Non-Hispanic BlackJAMA, 2006:295:
39 Costs of Obesity$75 billion: Annual U.S. medical expenditures attributed to obesity in 2003Amount obese people spent on health care costs compared to normal weight people: 37% moreFor Youth (6-17 years) between 1979 and 1999:Hospital discharges for diabetes were nearly 2xSleep apnea increased 5xObesity-associated costs were $35 million during and increased to $127 million duringAnnual costs associated with overweight and obesity in Texas in 2001: $10.5 billion dollarsProjected costs for 2040 in Texas: $39 billion in TexasUsed the 1994 national health interview survey.Put figures at 4.32% of national health expendituresSources: Surgeon General’s Report on Obesity, 2001;Finkelstein et al., 2004; Thorpe et al., 2004; Wang & Dietz,
40 Figure 1. Prevalence of BMI > 30 within BMI category; 11th grade FemaleMaleW = White, H = Hispanic, A = African American
41 2001 Grade 5 SAT 9 and Physical Fitness Stanford Achievement TestGives to students in grades 5, 7 & 9Used Fitnessgram to assess physical fitnessCA Dept. of Education, 2002
42 2001 Grade 7 SAT 9 and Physical Fitness Stanford Achievement TestGives to students in grades 5, 7 & 9Used Fitnessgram to assess physical fitnessCA Dept. of Education, 2002
43 2001 Grade 9 SAT 9 and Physical Fitness Stanford Achievement TestGives to students in grades 5, 7 & 9Used Fitnessgram to assess physical fitnessFitnessgram uses criterion-referenced standards to evaluate fitness. These represent a level of fitness that offers some degree of protection against chronic disease. Achievement of fitness standards is basd upon a test score that falls in the Healthy Fitness Zone. Each of the 6 tasks measures a different aspect of fitness.CA Dept. of Education, 2002
44 Defining Physical Activity Physical Activity = any bodily movement produced by skeletal muscles that results in an energy expenditure. It can be categorized in various ways, including type, intensity, and purpose. In terms of disease prevention, the activity usually considered is aerobic in nature, with large muscle groups contracting in a continuous mannerPhysical activity can be seen as a broader term than exercise
45 Defining Physical IN-Activity Physical IN-Activity = a level of activity less than that needed to maintain good health.Inactive as per CDC: less than 10 minutes per week of moderate or vigorous physical activitySallis and Owen, 1999: People are considered sedentary when they report no physicalNew Description! = Screen TimePhysical activity can be seen as a broader term than exercise
46 Defining Physical Fitness Physical Fitness = The ability to carry our daily tasks with vigor and alertness, without undue fatigue, and with ample energy to enjoy leisure-time pursuits and to meet unforeseen emergencies.A measure of a person’s ability to perform physical activities that require endurance, strength, flexibilityPhysical fitness is a measure of a person’s performance to perform physical activitiesFitness is a state of being that many people strive for
47 Defining ExerciseExercise = physical activity that is planned or structuredRepetitive movement to improve/ maintain:Aerobic capacityMuscular strengthMuscular enduranceFlexibilityBody compositionThe term exercise is commonly used interchangeably with physical activity but it refers to structured activities for attaining physical fitness.Exercise can increase aerobic conditioning, strength, endurance, flexibility, and body composition
48 Quantifying PA measures Need PA intensity measureNeed frequencyNeed durationBody weight may be needed
49 Outcome Measures 5 Health Related Components of PA Caloric Expenditure (CE)Activity Intensity (AI)Weight Bearing (WB)Flexibility (FL)Musculoskeletal (MS)
50 Physical activity intensity is frequently quantified in terms of metabolic equivalents, or METS 1 MET is rest (as in, 1 times your resting metabolic rate)1 MET = 1 kcal/kg/hrAll activities are some multiple of this resting MET level
52 Defining Recommended Activity Recommended Activity = minimum amount of physical activity required for health benefitsEither regular moderate or vigorous activities equivalent to burn 150 calories/day (1,000 calories/wk)Recommended activity is the minimum amount of activity for achieving a health benefitThat translates to the activity required to burn 150 calories per day, which can be accomplished with longer bouts of moderate activity or shorter bouts of vigorous activity
53 Physical Activity Types/Examples Vigorous ActivitiesBrisk walking or climbing uphillHigh Impact AerobicsStep aerobicsSwim lapsBicycling (hills)JoggingModerate ActivitiesWalking mph (level surface)Low Impact AerobicsSwimmingBicycling (level ground)Mowing grassPhysical activities are categorized as vigorous, moderate, and lightVigorous activities include…Moderate activities include…Note: Intensity of activity is often determined in metabolic equivalents (METS). METS estimate the metabolic cost of activity;1 MET=resting metabolic rate.
54 MeasurementSurvey: diary, recall, quantitative history, global self-report.Direct observation, job classificationHeart rate monitor, motion sensors, pedometer, gait assessment, accelerometers.Direct calorimetry (heat), indirect calorimetry (oxygen), cycle, treadmill, doubly labeled water (H and O).1.) Just to point out the different levels of precision with measurement. The data I will be presenting tonight is based on self-report, and thus, there may be more issues with measurement error- both in terms of validity of instruments in measuring physical activity as well as the biases the go along with data based on self-report.Calorimetry: some type of chamber to measure heat; doubly labeled water: they put an isotope and then measure urine…Gait analysis is the technical part of gait assessment. The patient walks up and down the laboratory, while special television cameras observe the positions of reflectors fixed to their skin. A computer uses these observations to provide detailed information on the way the patient walks.
55 Doubly Labeled WaterDrink water with 2H and 18O isotopes (natural isotopes)Urine or saliva samples collected pre-drink, and every few days up to ~14 daysAssumption: 2H disappears in H2O and 18O disappears in H2O and CO2 removalDifferential loss is equivalent to EE
56 Doubly Labeled Water 3 Disadvantages Isotope is very expensive (~$500 per subject)Expensive equipment needed for analysisAssumes that CO2 ~ O2Only Total EE is measuredComponents of PA?
57 Activity Monitors Assessing PA What are accelerometers?They measure accelerations of the human bodyThey record activity patterns over a period of timeBenefits: small, non-invasive, large storage capacity, used widely in field settingsDifferent types:Actigraph (or CSA) - most widely usedCaltrac - estimates energy expenditureTritrac - measures PA in 3 directions(Welk, 2002)
58 The Actigraph Records levels of PA Worn on waist, wrist or ankle Records frequency, time and intensity of PACan detail percentage time spent at different activity levelsMonitors continuously
59 Paediatric monitoring Used in the Liverpool Sporting Playgrounds ProjectQuantified intensity, duration and frequency of activity in playtime (10 year-old girl's data shown)Moderate PA: 46% (6½ mins)High PA: 11% (1¾ mins)Very high PA: 5.6% (1 min)
60 Heart Rate MonitorsHRM measure cardiorespiratory response to physical activityTransmitter and belt worn around the upper bodyData commonly displayed on a wrist receiverDownloaded via interface for analysis
61 Heart Rate Monitors Advantages Limitations Relationship with energy expenditureValid & reliable in lab & fieldDescribes tempoEasy & quick for data collection & analysesLimitationsCost (large samples)Data attritionDiscomfort over long periodsAge, sex, training status affect HRNo information on physical activity context
62 Direct observation instruments Measure behavioural aspects of physical activityProvides information on specific activities occurring in a variety of settings over timeQuantitative & qualitative informationUseful with younger childrenTrained observersPen and paper instruments
63 Direct observation instruments AdvantagesDetailed quantitative & qualitative dataDescribes tempoLow financial costComputer software allows real time recording & analysis of dataLimitationsTime-intensive trainingTime & labour intensive data collectionLimited sample sizesObserver presence (reactivity)Limited validation against physiological criteria
64 System for Observing Children's Activity during Playtime (SOCAP) Recording Form Time Area Activity Activities Behaviour OtherLevelB St T A T to LA4G W W & T Linked armsB V Tick2B W-V Chasing PFSystem for Observing Children's Activity during Playtime (SOCAP)Assesses levels of activity engaged in on playground & types of activities (e.g. skipping)Details main behaviours displayed during playtime (e.g. play fighting, arguing)Benefits: combines PA with behaviours and identifies contextual influences on PALimitations: new measure which is currently undergoing reliability & validity studies
65 Physical Activity Questionnaires International Physical Activity Questionnaire (IPAQ)Physical Activity Questionnaire for Adolescents (PAQ-A)Leisure Time Exercise Questionnaire (LTEQ)AdvantagesInexpensive, allows large sample size.Can be administered quickly and easily.LimitationsReliability and validity problems associated with recall of activity, especially in children.Lack objectivity.Various types of questionnaire that can be used to measure PASelf-report questionnaireInterviewer administered questionnairesProxy (e.g. given by parents on their child’s PA levels) reportsPAQ-A (Kowalski et al., 1997) and LTEQ (Godin and Shepard, 1985)Objective: to classify individuals into broad categories of activity and provide some basic quantification of the major behavioural characteristics of the activity patterns reported.Useful for descriptive studies designed to assess the prevalence of various activity patterns in large populations.Questionnaires are relatively inexpensive and enable PA to be estimated in large numbers of individuals while maintaining low investigator burden.BUT there are some inherent problems associated with recall of PA especially in children and the data collected are largely subjective.The IPAQ measures frequency, intensity and duration BUT not type of PA.Measures = Frequency, Intensity, Time (and Energy Expenditure).
66 Pedometers Ped- Walk Meters-measure Fixed to waistband Small-light-unobtrusiveDisplay:- Steps Distance KcalsTarget:-Adult:- 10,000 steps/dayChildren:- 127 steps per minute. 60 mins=8000 steps/day
67 Expediency vs Accuracy Heart rate monitoringAccelerometryActiheartGPS systemsDirect ObservationDoubley labelled waterQuestionnaires Long ShortPedometersCost
68 Physical Activity Surveillance Routine surveillanceYouth Risk Behavior SurveyBehavior Risk Factor Surveillance SystemNational Health and Nutrition Examination SurveyNational Health Interview SurveyNational Personal Transportation SurveyPediatric Nutrition Surveillance SystemCross-sectional or population studies
69 Guide to Community Preventive Services (www.thecommunityguide.org/pa) Community-wide campaigns. Large-scale, highly visible, multicomponent campaigns with messages promoted to large audiences through diverse media, including television, radio, newspapers, movie theaters, billboards, and mailings.Individually targeted programs. Programs tailored to a person’s readiness for change or specific interests; these programs help people incorporate physical activity into their daily routines by teaching them behavioral skills such as setting goals, building social support, rewarding themselves for small achievements, solving problems, and avoiding relapse.School-based physical education (PE). School curricula and policies that require students to engage in sufficient moderate to vigorous activity while in school PE class. Schools can accomplish this by increasing the amount of time students spend in PE class or by increasing their activity level during PE class.
70 Guide to Community Preventive Services (www.thecommunityguide.org/pa) Interventions that provide social support for physical activity in community settings. Interventions designed to promote physical activity by helping people create, strengthen, and maintain social networks that support their efforts to exercise more; examples include exercise buddy programs and the establishment of exercise contracts or walking groups.Interventions to provide people greater access to places for physical activity. Examples include building walking or biking trails and making exercise facilities available in community centers or workplaces.
71 U.S. and Texas adults who meet physical activity guidelines- 2003 Mod PA: 47% for U.S. compared to 44% for Texas; 26% for both1.) more than 50% of Americans do not get enough PA to provide health benefits2.) 26% are not active at all in their leisure time.Source: CDC BRFSS
72 Physical activity among U.S. adults by gender- 2003 Mod PA= moderate intensity activities as reported in a week for 30 minutes per day, five days a week;Inactive: less than 10 minutes total per week of moderate or vigorous PASource: CDC BRFSS
73 Physical activity among U.S. adults by race/ethnicity- 2003 Mod PA= moderate intensity activities as reported in a week for 30 minutes per day, five days a week;Inactive: less than 10 minutes total per week of moderate or vigorous PASource: CDC BRFSS
74 Physical activity among U.S. adults by age- 2003 Mod PA= moderate intensity activities as reported in a week for 30 minutes per day, five days a week;Inactive: less than 10 minutes total per week of moderate or vigorous PASource: CDC BRFSS
75 Percentage of U.S. adults who meet physical activity recommendations by education level: 2003 Recommended physical activity is defined as reported moderate-intensity activities in a usual week (i.e., brisk walking, bicycling, vacuuming, gardening, or anything else that causes small increases in breathing or heart rate) for at least 30 minutes per day, at least 5 days per week; or vigorous-intensity activities in a usual week (i.e., running, aerobics, heavy yard work, or anything else that causes large increases in breathing or heart rate) for at least 20 minutes per day, at least 3 days per week or both. This can be accomplished through lifestyle activities (i.e., household, transportation, or leisure-time activities).Source: CDC BRFSS
76 Physical activity among U.S. adults by poverty level- 1999-2001 Percent distributions of times per week engaged in vigorous and moderate leisure-time physical activity for adults 18 years of age and over, by selected characteristics: United States, average annual, 1999–2001Source: NHIS
77 No leisure-time physical activity among U. S No leisure-time physical activity among U.S. adults by poverty levelNo moderate PA ranges from 61.5% for below poverty level to 36.5% for 4 times the poverty level; Vigorous 72.9% for below poverty to 47.3% for 4xs poverty.Source: NHIS
78 Physical Activity & U.S. Adults PrevalenceMore than 50% of adult Americans do not get enough PA to provide health benefits26% are not active at all in their leisure time (BRFSS, 2003;)/ 38.6% according to National Health Interview SurveyGenderMen (64.2%) more likely than women (59%) to engage in some leisure-time physical activity;Men more likely than women to engage in light moderate and/or vigorous physical activity than women five times per week. (NHIS, CDC 2004).EthnicityWhite adults (63.5%) and Asian adults (61.9%) were more likely than African American adults to engage in some leisure-time physical activity (NHIS, CDC 2004).White adults (49%) more likely to meet moderate PA guidelines compared to African American (36%) and Hispanics (37%). (BRFSS, 2003)Whites (12%) reported lower inactivity compared to African Americans (24%) and Hispanics (26%) (BRFSS, 2003)Is increase in Moderate PA due to measurement, with accumulated PA accounting for increase?Source: CDC
79 Physical Activity & U.S. Adults AgeEngagement in physical activity declines steadily with age.EducationPhysical activity increases with educational level.Adults with a graduate degree (81%) were about twice as likely as adults with less than a high school diploma (41%) to engage in at least some leisure-time physical activity (NHIS, 2004).Adults with highest educational attainment were almost twice as likely as adults with the least education to engage in light-moderate or vigorous activities five or more times per week (NHIS, 2004).Women with a bachelor’s degree & graduate-level degree were four times as likely as women with less than a high school diploma to engage in strengthening exercise. (NHIS, 2004)PovertyAdults with incomes four times the poverty level or more (29.1%) were more likely than adults with incomes below the poverty level (20.5%) to engage in light-moderate physical activity at least five times per week and more than two times as likely to engage in vigorous physical activity (17.9% and 7.0%, respectively).Is increase in Moderate PA due to measurement, with accumulated PA accounting for increase?Source: CDC
80 Physical Activity & U.S. Adults Geographic RegionAdults living in the West were more likely to engage in any regular physical activity (35%) and adults living in the south (28.4%) were least likely to engage in any regular physical activity.Adults living in a Metropolitan Statistical Area were more likely than adults living outside an MSA and adults living in the central city of an MSA to engage in at least some leisure-time physical activity (64%, 59%, and 59%, respectively).Marital StatusMarried women (61.0%) were more likely than women in any other marital status group to engage in at least some leisure-time physical activity. (NHIS- CDC, 2004)Widowed adults (23.6%) were less likely than never married (33.0%), married (31.1%) and divorced or separated adults (29.1%) to engage in regular physical activity.Adults who had never been married (27.5%) were more likely than adults in any other marital status group to engage in strengthening activities. (NHIS – CDC-NCHS, 2004)TrendsLeisure-time physical activity appears to have increased slightly from 1991 (71.3%) to 2003 (75.6%)Is increase in Moderate PA due to measurement, with accumulated PA accounting for increase?Source: CDC-NCHS:National Health Interview Survey,
81 U.S. Youth Participation in Sufficient Vigorous (V) and Moderate (M) Physical Activity Levels by Gender (Grades 9-12)Vig: Female: white; 44.9 black, 51.8 Hispanic; Male: 71.9; 65.0; 66.7; mod female: 23.2 white, 17.5 AA, 20.6 Hispanic; male; 28.9 white, 25,8 AA, 23.3 Hispanic1.) More than a third of young people in grades 9-12 do not engage in sufficient vigorous physical activity.Source: CDC YRBS 2003
82 U.S. Youth Participation in Sufficient Vigorous and Moderate Physical Activity Levels by Ethnicity (Grades 9-12): 2003Vigorous: white (65.2), black (54.8), hispanic (59.3); Moderate: white (26.2), black (21.7), Hispanic (22.0)Source: CDC YRBS 2003
83 U.S. Youth Participation in Sufficient Vigorous (V) Physical Activity Levels by Grade and Sex Source: CDC YRBS 2003
84 U.S. Youth Physical Activity Levels by Age and Sex: Vigorous (V) and Moderate (M) Source: CDC YRBS
85 Trends in Prevalence of Physical Activity among U.S. Youth: 1991-2003 **1.) Slight drop in vigorous physical activity, still around a third who do not get enough vigorous activity (66% in 91 to 63% in 2003).2.) Slight increase in participation in strengthening exercises that was statistically significant, from 48% in 1991 to 52% in 2003.3.) Decrease in daily participation in Physical Education classes, with biggest drop occurring between 1991 and 1994 (42% in 91 to 25% in ’95)Daily participation in high school physical education classes dropped from 42% in 1991 to around 28% in 2003.*Significant changes over timeSource: CDC YRBS
86 Reported Physical Activities from Mid to Late Adolescence - Boys Physical Activity% Participants- 1990% Participants-1993Basketball6659Football42Bicycling583Baseball5529Street hockey30Weight lifting3140Aaron et al., 2002, Arch Pediatr Adolesc Med
87 Reported Physical Activities from Mid to Late Adolescence - Girls Physical Activity% Participants- 1990% Participants-1993Bicycling522Softball3622Basketball3418Running2928Aerobics2023Bowling1910Aaron et al., 2002, Arch Pediatr Adolesc Med
88 Prevalence of Obesity by Daily Hours of TV Watching U. S Prevalence of Obesity by Daily Hours of TV Watching U.S. children aged 8 – 16,Crespo et al., Arch Ped Adol Med ;155:
89 Physical Activity & Youth Prevalence of Physical Activity & InactivityMore than a third of young people in grades 9-12 do not engage in sufficient vigorous physical activity.About 14% of young people report no recent physical activity.Only 19 percent of high school students are physically active for 20 minutes or more, five days a week, during physical education classes.38% of youth watch ≥3 hours of TV on a school dayGenderPhysical activity is higher among male adolescents, and inactivity is more common among females than males (14% vs. 7%).EthnicityPhysical activity levels differ by race/ethnicity, with white adolescents appearing to engage in more physical activity than African American and Hispanic adolescentsSource: CDC
90 Physical Activity & Youth AgeParticipation in all types of physical activity declines strikingly as grade in school and age increases.Trends:Slight drop in vigorous physical activity, with around a third who do not get enough vigorous activity (66% in ‘91 to 63% in 2003).Slight increase in participation in strengthening exercises that was statistically significant, from 48% in 1991 to 52% in 2003.Daily participation in high school physical education classes dropped from 42% in 1991 to around 28% in 2003.Source: CDC