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 Dilemma
Most Americans are not physically active enough to achieve substantial health benefit
Related disease outcomes are very costly
With adults, traditional PA promotion efforts have had limited effect
Sustaining higher activity levels will require a comprehensive approach
I would summarize our current dilemma this way:
most of us are not physically active enough to achieve a substantial health benefit
the human and financial burden from diseases related to physical inactivity is huge
traditional efforts to promote physical activity have generally been limited to individual behavior change approaches, neglecting the role of the built environment
comprehensive 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, school
Stay 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 recreation
Information 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 change
Behavioral settings: schools, homes, neighborhoods, communities, youth-serving organizations, child care centers, grocery and convenience stores, restaurants/fast food outlets, vending machines, worksites
Although 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) causes
Mass media saturated with unhealthy messages and advertising
Proliferation of easily available low nutrient, calorie dense foods
Increasing frequency of restaurant eating and larger portion sizes (Super Size Me!)

6. The (possible) causes
Increasing amount of time spent indoors with mass media and games
Increased car travel and less person-powered transport
Increased concerns over child safety - stranger danger and traffic
Fewer walkable destinations - shops, grocery, post office

7. The (possible) causes
More 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 play
Personal injury litigation and reduced opportunities for physical activity
Poor fundamental movement skills - as children participate less, they fail to develop these fundamental skills so want to participate less

8. The (possible) causes
Schools increasingly reluctant to devote time to health education
Poor 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 to
public health measures: 25
Increased years due to
medical care advances: 5
Source: Centers for Disease Control and Prevention (CDC).

14. Causes of Death in United States – 2002
Actual Causes of Death2
Leading Causes of Death1
Heart Disease
Tobacco
Cancer
Poor diet/ lack of exercise3
Stroke
Alcohol
Chronic lower respiratory disease
Infectious agents
Unintentional Injuries
Pollutants/toxins
Diabetes
Firearms
Pneumonia/influenza
Sexual behavior
Alzheimer’s disease
Motor vehicles
Kidney Disease
Illicit drug use
Percentage (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 control
Decreases 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-being
Related 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 osteoporosis
18 % fewer cases of type 2 diabetes and hypertension
16 % fewer injuries from falls in the elderly
12 % fewer cases of depression and anxiety
5 % fewer cases of breast cancer
PA 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 Easy
Achieving 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 Fitness
Aim for a healthy weight
Be physically active each day
Build a Healthy Base
Let the Pyramid guide your food choices
Choose a variety of grains daily, especially whole grains
Choose a variety of fruits and vegetables daily
Keep food safe to eat

20. Dietary Guidelines for Americans
Choose Sensibly
Choose a diet that is low in saturated fat and cholesterol and moderate in total fat
Choose beverages and foods to moderate your intake of sugars
Choose and prepare foods with less salt
If you drink alcoholic beverages, do so in moderation

21. Vegetables and Fruits
5 or more servings of vegetables and fruits each day
Research suggests this one dietary change could prevent as many as 20% of all cancers
Vegetables and fruits provide vitamins, minerals, and phytochemicals
Variety 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 legumes
Whole grains are higher in fiber, vitamins, minerals, and phytochemicals than refined grains

23. The New American Plate
2/3 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 products
1/3 or less of the plate should be covered by meat, fish, poultry, or low-fat dairy

24. Physical Activity
Engage 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 disease
Up to 60 minutes of moderate to vigorous physical activity may be needed to prevent gradual weight gain that occurs over time
60 to 90 minutes of moderate-intensity physical activity to sustain weight loss
Recommendations for specific populations
Those who need to lose weight, overweight children, pregnant women, breastfeeding women, overweight adults and overweight children with chronic diseases and/or on medication

26. Change May Occur Slowly

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 1990
No 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 1995
No 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 2000
No 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 2001
No 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 > 30
NHANES
These 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 Black
JAMA, 2006:295:

39. Costs of Obesity
$75 billion: Annual U.S. medical expenditures attributed to obesity in 2003
Amount obese people spent on health care costs compared to normal weight people: 37% more
For Youth (6-17 years) between 1979 and 1999:
Hospital discharges for diabetes were nearly 2x
Sleep apnea increased 5x
Obesity-associated costs were $35 million during and increased to $127 million during
Annual costs associated with overweight and obesity in Texas in 2001: $10.5 billion dollars
Projected costs for 2040 in Texas: $39 billion in Texas
Used the 1994 national health interview survey.
Put figures at 4.32% of national health expenditures
Sources: 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
Female
Male
W = White, H = Hispanic, A = African American

41. 2001 Grade 5 SAT 9 and Physical Fitness
Stanford Achievement Test
Gives to students in grades 5, 7 & 9
Used Fitnessgram to assess physical fitness
CA Dept. of Education, 2002

42. 2001 Grade 7 SAT 9 and Physical Fitness
Stanford Achievement Test
Gives to students in grades 5, 7 & 9
Used Fitnessgram to assess physical fitness
CA Dept. of Education, 2002

43. 2001 Grade 9 SAT 9 and Physical Fitness
Stanford Achievement Test
Gives to students in grades 5, 7 & 9
Used Fitnessgram to assess physical fitness
Fitnessgram 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 manner
Physical 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 activity
Sallis and Owen, 1999: People are considered sedentary when they report no physical
New Description! = Screen Time
Physical 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, flexibility
Physical fitness is a measure of a person’s performance to perform physical activities
Fitness is a state of being that many people strive for

47. Defining Exercise
Exercise = physical activity that is planned or structured
Repetitive movement to improve/ maintain:
Aerobic capacity
Muscular strength
Muscular endurance
Flexibility
Body composition
The 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 measure
Need frequency
Need duration
Body 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/hr
All activities are some multiple of this resting MET level

52. Defining Recommended Activity
Recommended Activity = minimum amount of physical activity required for health benefits
Either 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 benefit
That 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 Activities
Brisk walking or climbing uphill
High Impact Aerobics
Step aerobics
Swim laps
Bicycling (hills)
Jogging
Moderate Activities
Walking mph (level surface)
Low Impact Aerobics
Swimming
Bicycling (level ground)
Mowing grass
Physical activities are categorized as vigorous, moderate, and light
Vigorous 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. Measurement
Survey: diary, recall, quantitative history, global self-report.
Direct observation, job classification
Heart 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 Water
Drink water with 2H and 18O isotopes (natural isotopes)
Urine or saliva samples collected pre-drink, and every few days up to ~14 days
Assumption: 2H disappears in H2O and 18O disappears in H2O and CO2 removal
Differential loss is equivalent to EE

56. Doubly Labeled Water 3 Disadvantages
Isotope is very expensive (~$500 per subject)
Expensive equipment needed for analysis
Assumes that CO2 ~ O2
Only Total EE is measured
Components of PA?

57. Activity Monitors Assessing PA
What are accelerometers?
They measure accelerations of the human body
They record activity patterns over a period of time
Benefits: small, non-invasive, large storage capacity, used widely in field settings
Different types:
Actigraph (or CSA) - most widely used
Caltrac - estimates energy expenditure
Tritrac - 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 PA
Can detail percentage time spent at different activity levels
Monitors continuously

59. Paediatric monitoring
Used in the Liverpool Sporting Playgrounds Project
Quantified 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 Monitors
HRM measure cardiorespiratory response to physical activity
Transmitter and belt worn around the upper body
Data commonly displayed on a wrist receiver
Downloaded via interface for analysis

61. Heart Rate Monitors Advantages Limitations
Relationship with energy expenditure
Valid & reliable in lab & field
Describes tempo
Easy & quick for data collection & analyses
Limitations
Cost (large samples)
Data attrition
Discomfort over long periods
Age, sex, training status affect HR
No information on physical activity context

62. Direct observation instruments
Measure behavioural aspects of physical activity
Provides information on specific activities occurring in a variety of settings over time
Quantitative & qualitative information
Useful with younger children
Trained observers
Pen and paper instruments

63. Direct observation instruments
Advantages
Detailed quantitative & qualitative data
Describes tempo
Low financial cost
Computer software allows real time recording & analysis of data
Limitations
Time-intensive training
Time & labour intensive data collection
Limited sample sizes
Observer presence (reactivity)
Limited validation against physiological criteria

64. System for Observing Children's Activity during Playtime (SOCAP) Recording Form
Time Area Activity Activities Behaviour Other
Level
B St T A T to LA
4G W W & T Linked arms
B V Tick
2B W-V Chasing PF
System 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 PA
Limitations: 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)
Advantages
Inexpensive, allows large sample size.
Can be administered quickly and easily.
Limitations
Reliability and validity problems associated with recall of activity, especially in children.
Lack objectivity.
Various types of questionnaire that can be used to measure PA
Self-report questionnaire
Interviewer administered questionnaires
Proxy (e.g. given by parents on their child’s PA levels) reports
PAQ-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-unobtrusive
Display:- Steps Distance Kcals
Target:-
Adult:- 10,000 steps/day
Children:- 127 steps per minute. 60 mins=8000 steps/day

67. Expediency vs Accuracy
Heart rate monitoring
Accelerometry
Actiheart
GPS systems
Direct Observation
Doubley labelled water
Questionnaires Long Short
Pedometers
Cost

68. Physical Activity Surveillance
Routine surveillance
Youth Risk Behavior Survey
Behavior Risk Factor Surveillance System
National Health and Nutrition Examination Survey
National Health Interview Survey
National Personal Transportation Survey
Pediatric Nutrition Surveillance System
Cross-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 both
1.) more than 50% of Americans do not get enough PA to provide health benefits
2.) 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 PA
Source: 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 PA
Source: 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 PA
Source: 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, 1999–2001
Source: NHIS

77. No leisure-time physical activity among U. S
No leisure-time physical activity among U.S. adults by poverty level
No 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
Prevalence
More than 50% of adult Americans do not get enough PA to provide health benefits
26% are not active at all in their leisure time (BRFSS, 2003;)/ 38.6% according to National Health Interview Survey
Gender
Men (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).
Ethnicity
White 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
Age
Engagement in physical activity declines steadily with age.
Education
Physical 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)
Poverty
Adults 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 Region
Adults 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 Status
Married 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)
Trends
Leisure-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 Hispanic
1.) 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): 2003
Vigorous: 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 time
Source: CDC YRBS

86. Reported Physical Activities from Mid to Late Adolescence - Boys
Physical Activity
% Participants- 1990
% Participants-1993
Basketball 66 59
Football 42
Bicycling 58 3
Baseball 55 29
Street hockey 30
Weight lifting 31 40
Aaron et al., 2002, Arch Pediatr Adolesc Med

87. Reported Physical Activities from Mid to Late Adolescence - Girls
Physical Activity
% Participants- 1990
% Participants-1993
Bicycling 52 2
Softball 36 22
Basketball 34 18
Running 29 28
Aerobics 20 23
Bowling 19 10
Aaron 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 & Inactivity
More 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 day
Gender
Physical activity is higher among male adolescents, and inactivity is more common among females than males (14% vs. 7%).
Ethnicity
Physical activity levels differ by race/ethnicity, with white adolescents appearing to engage in more physical activity than African American and Hispanic adolescents
Source: CDC

90. Physical Activity & Youth
Age
Participation 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