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Supporting the National Physical Activity Plan

Policy Date: 10/30/2012
Policy Number: 20121

Related APHA Policy Statements

APHA Policy Statement 9709 – Promoting Public Health Through Physical Activity

APHA Policy Statement 2004-04 – Creating Policies on Land Use and Transportation Systems that Promote Public Health

APHA Policy Statement 2005-8 – Supporting the WHO Global Strategy on Diet, Physical Activity and Health

APHA Policy Statement 200619 – Urgent Call for a Nationwide Public Health Infrastructure and Action to Reverse the Obesity Epidemic

APHA Policy Statement 20079 – Building a Public Health Infrastructure for Physical Activity Promotion

Abstract

In spite of the numerous health promotion and disease prevention benefits of physical activity, national surveillance indicates that many American adults, adolescents, and children are not engaging in enough physical activity to achieve these health benefits. To support improvement in population levels of this health-promoting behavior, the US Department of Health and Human Services released the first comprehensive federal Physical Activity Guidelines for Americans in 2008. In order to identify policies, practices, and initiatives that will increase population levels of physical activity to the guideline standards, the National Physical Activity Plan was developed and adopted in May of 2010. The purpose of the National Physical Activity Plan is to provide a roadmap for actions that support progress in increasing Americans’ physical activity with ongoing implementation and evaluation. The plan includes recommended strategies focused on eight sectors, and each sector presents strategies aimed at promoting physical activity. Each strategy also outlines specific tactics that communities, organizations and agencies, and individuals can use to address the strategy. Organizational partners of the National Physical Activity Plan include federal agencies, advocacy agencies, national nonprofit organizations, and national professional organizations. Recognizing the importance of a strategic plan to improve population physical activity rates in the United States can help facilitate state and local implementation of National Physical Activity Plan strategies as well as encourage individuals to adopt and maintain a physically active lifestyle to help achieve the plan’s goals.

Problem Statement

Physical activity has an important role in population health.[1] There is strong evidence to support the association between physical activity and all-cause mortality.[2] Evidence also shows that physical activity improves cardiorespiratory health[3–6] and contributes to metabolic,[4,7–10] musculoskeletal,[4,11–13] and mental[4,14,15] health. In addition, research shows that physical activity can contribute to the prevention of breast and colon cancer.[4]

However, national surveillance indicates that many American adults are not engaging in enough physical activity to achieve these health benefits. Only 51% of American adults engage in the recommended amounts of physical activity, and almost 24% report no physical activity at all in the past 30 days.[16] Only 18.4% of adolescents in grades 9–12 participate in recommended amounts of physical activity, with 23% reporting no physical activity in the past 7 days.[17] There is also evidence of disparities among population subgroups. White adults are more likely to be physically active (61.9%) than Black adults (48.8%) and Hispanic adults (46.5%). Also, minority populations are more physically inactive and report having fewer opportunities and access to places to engage in physical activity.[18]
Lower educational attainment corresponds to higher proportions of physical inactivity, and this disparity has persisted over time.[19] People with disabilities are also less likely to engage in regular moderate physical activity than people without disabilities, yet they have similar needs to promote their health and prevent unnecessary disease.[20]

Proposed Recommendations Statement

To support improvement in population levels of this health-promoting behavior, the US Department of Health and Human Services released the first comprehensive federal Physical Activity Guidelines for Americans in 2008.[4] These guidelines provide the public with science-based guidance on the types and amounts of physical activity needed to maintain health and prevent disease. In order to identify policies, practices, and initiatives that will increase population levels of physical activity to the guideline standards, the National Physical Activity Plan was developed and adopted in May of 2010.[21] The purpose of the National Physical Activity Plan is to provide a clear roadmap for actions that support short- and long-term progress in increasing Americans’ physical activity levels[21,22] with an ongoing implementation and evaluation plan. The plan is being evaluated by the Physical Activity Policy Research Network, a network of physical activity experts funded by the Centers for Disease Control and Prevention (CDC). The evaluation incorporates analyses of sector reports as they relate to progress on strategies and tactics, including those focused on vulnerable populations.
It also includes ongoing interviews with practitioners on how the plan is being used to guide state efforts.

The National Physical Activity Plan aligns with other national strategies. The National Prevention Strategy published in 2011 includes active living as one of its priorities. It recommends that Americans live, work, and learn in environments that provide safe and accessible options for physical activity, regardless of age, income level, or disability status.[23] The Prevention Strategy encompasses 6 of the 8 sectors addressed in the National Physical Activity Plan. In addition, the US Department of Health and Human Services Action Plan to Reduce Racial and Ethnic Health Disparities outlines goals, strategies, and actions that include increased prevention efforts. Physical activity is mentioned as one of these efforts.[24] The National Physical Activity Plan promotes physical activity in all segments of the American population, and it also outlines strategies and tactics that focus on vulnerable and at-risk populations.

The National Physical Activity Plan includes recommended strategies based on evidence, emerging evidence, or best practices within 8 sectors.[22] Each sector presents strategies aimed at promoting physical activity, as follows.

• Public health: Strategies in this sector focus on training, partnerships, policy advocacy, dissemination, and evaluation. Relevant examples of tactics to implement these public health strategies include:
- Encouraging national and state public health associations to form physical activity sections within their organizations.
- Expanding recruitment, outreach, and training efforts (e.g., through scholarship programs sponsored by professional societies) to engage ethnic minority students, students with disabilities, and students representing groups at particular risk of physical inactivity.
- Creating an interdisciplinary policy and advocacy center to support advocacy efforts and policy development for physical activity in public health agencies.
- Disseminating physical activity–promoting practices and policies targeted at agencies and professional societies outside of public health (e.g., youth-serving social services and nonprofit organizations in underserved communities).

• Health care: Strategies in this sector focus on provider education and delivery of physical activity information to patients, reducing disparities in access to this information and advocating for policies that facilitate these strategies. Tactics address underserved populations through ensuring that groups at high risk for chronic disease and inactivity have equal or better access to physical activity services in clinical settings than the general patient population

• Education: Strategies include increasing access/opportunities in schools and preschools, developing partnerships and training, and implementing policies to support physical activity. Tactics address underserved populations through recommending the provision of local, state, and national funding to ensure that schools have the resources (e.g., facilities, equipment, appropriately trained staff) to provide high-quality physical education and activity programming. The largest portion of funding should be designated for schools that are underresourced, and states should be offered assistance in identifying areas of greatest need.

• Transportation, land use, and community design: Strategies in this sector focus on accountability for infrastructure improvement, prioritizing resources, integrating disciplines, and facilitating active transportation. Tactics address underserved populations through increased accountability in planning with respect to equity and disparity issues, especially among vulnerable communities and populations.

• Parks, recreation, fitness, and sports: Strategies include promoting access, enhancing physical activity opportunities, training, marketing, and monitoring. Tactics address underserved populations through community efforts to improve access to and the safety and security of parks and recreation, fitness, and sports facilities, especially in low-resource and high-crime neighborhoods.

• Business and industry: Strategies in this sector focus on best practices, multisector partnerships, training, policies, and evaluation. Tactics address underserved populations through the development of specific approaches that are appealing to worksites with large numbers of lower income and ethnic minority workers.

• Volunteer and nonprofit organizations: Strategies include advocating for policies, facilitating stakeholder partnerships, and engaging in outreach. Tactics address underserved populations (e.g., low-income, underserved, and/or minority populations and people with disabilities) through enhanced strategies, such as culturally tailored programs, materials, and communication channels.

• Mass media: Strategies integrate the other sectors in developing and promoting consistent messaging about physical activity. Tactics address underserved populations through identifying local community organizations and communications vehicles with which to partner in targeting underserved communities.

Each strategy also outlines specific tactics that communities, organizations and agencies, and individuals can use to address the strategy. Recognizing that some strategies encompass multiple sectors, the plan also several overarching strategies as well.

Organizational partners of the National Physical Activity Plan include federal agencies, advocacy agencies, national nonprofits, and national professional organizations:

• Active Living Research
• American Academy of Pediatrics
• American Alliance for Health, Physical Education, Recreation and Dance
• American Association of Cardiovascular and Pulmonary Rehabilitation
• American Association of Retired Persons
• American Cancer Society
• American College of Sports Medicine
• American Diabetes Association
• American Dietetic Association
• American Heart Association
• American Medical Association
• American Physical Therapy Association
• Centers for Disease Control and Prevention
• National Academy of Sports Medicine
• National Athletic Trainers Association
• National Coalition for Promoting Physical Activity
• Road Runners Club of America
• United States Department of Agriculture
• United States Department of Health and Human Services
• YMCA

In addition to partners, there are many affiliate organizations that recognize the importance of this plan and have committed to promoting the strategies to increase physical activity within their constituency.

APHA is an association of individuals and organizations working to improve the public’s health and to achieve equity in health status for all. Evidence supports the role of physical activity in health promotion and disease prevention. By recognizing the importance of a strategic plan to improve physical activity rates in the United States, the American Public Health Association is supporting its mission.

Opposing Arguments/Evidence

Opposition to the National Physical Activity Plan may come from fiscal conservatives or others who believe that spending tax dollars on government programs to promote physical activity should not be a financial priority during a budget crisis. Even though physical activity promotion may not lead to immediate economic benefits, there is the potential for future cost savings from reduced health care costs related to diseases and conditions in which physical inactivity is a known risk factor, such as cardiovascular disease, diabetes, obesity, and cancer. According to a recent study, medical costs in the United States associated with treatment of these preventable diseases and conditions are estimated to increase by $48 to $66 billion per year.[10] However, financial estimates indicate that more than $31 billion can be saved annually via modest increases in population rates of regular physical activity, with the largest potential for these savings among employers and health insurers.[25] Communicating these costs and disseminating evidence on cost savings to all sectors of society can aid in promoting physical activity as an ongoing national, state, private industry, and personal health priority.

Others may oppose the plan because they believe that active living is a matter of personal choice instead of governmental responsibility. This controversy represents the fundamental dispute about the role of the individual versus society in health promotion and health care, which plays out in many different forms at the national, state, and local levels. While opponents may believe that government intervention limits personal choices in this realm, supporters would argue that the National Physical Activity Plan actually increases personal choice by providing more opportunities and greater access to physical activity facilities and programs to underserved individuals who previously had few choices available to them.

Alternative Strategies

Several states have physical activity goals as part of their obesity plans, although these plans vary in quality and depth. [9] The National Physical Activity Plan can serve as a model for state plans, facilitating consistent strategies and outcomes.

Action Steps

This resolution shows APHA’s firm support of the National Physical Activity Plan and will help implement strategies recommended in the plan by:

• Forming partnerships with other national and state organizations to disseminate and promote the National Physical Activity Plan.

• Urging state and local health departments and other public- and private-sector organizations to adopt strategies recommended in the National Physical Activity Plan.

• Encouraging individual members and staff to adopt and maintain a physically active lifestyle as recommended by the National Physical Activity Plan through the implementation of policies and programs.

• Facilitating support for federal transportation, education, environmental, and health legislation that directly or indirectly promotes physical activity.

• Providing an emphasis on the importance and need for culturally specific and tailored interventions to improve overall conditions in the environment that contribute to population disparities.

References

1. Centers for Disease Control and Prevention. Guide to community preventive services—promoting physical activity: environmental and policy approaches. Available at: www.thecommunityguide.org/pa/environmental-policy/index.html. Accessed August 27, 2011.
2. US Department of Health and Human Services. Physical Activity Guidelines Advisory Committee Report. Washington, DC: Office of Disease Prevention and Health Promotion; 2008.
3. Swain DP, Franklin BA. VO(2) reserve and the minimal intensity for improving cardiorespiratory fitness. Med Sci Sports Exerc. 2002;34(1):152–157.
4. 2008 Physical Activity Guidelines for Americans. Washington, DC: US Department of Health and Human Services; 2008.
5. Wenger HA, Bell GJ. The interactions of intensity, frequency and duration of exercise training in altering cardiorespiratory fitness. Sports Med. 1986;3(5):346–356.
6. Williams MA, Haskell WL, Ades PA, et al. Resistance exercise in individuals with and without cardiovascular disease: 2007 update: a scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2007;116(5):572–584.
7. Bassuk SS, Manson JE. Epidemiological evidence for the role of physical activity in reducing risk of type 2 diabetes and cardiovascular disease. J Appl Physiol. 2005;99(3):1193–1204.
8. Ferreira I, Twisk JW, van Mechelen W, Kemper HC, Stehouwer CD. Development of fatness, fitness, and lifestyle from adolescence to the age of 36 years: determinants of the metabolic syndrome in young adults: the Amsterdam Growth and Health Longitudinal Study. Arch Intern Med. 2005;165(1):42–48.
9. Laaksonen DE, Lakka HM, Salonen JT, Niskanen LK, Rauramaa R, Lakka TA. Low levels of leisure-time physical activity and cardiorespiratory fitness predict development of the metabolic syndrome. Diabetes Care. 2002;25(9):1612–1618.
10. Lakka TA, Laaksonen DE. Physical activity in prevention and treatment of the metabolic syndrome. Appl Physiol Nutr Metab. 2007;32(1):76–88.
11. Howe TE, Shea B, Dawson LJ, et al. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev. 2008(7):CD000333.
12. Ringsberg KA, Gardsell P, Johnell O, Josefsson PO, Obrant KJ. The impact of long-term moderate physical activity on functional performance, bone mineral density and fracture incidence in elderly women. Gerontology. 2001;47(1):15–20.
13. Sinaki M, Itoi E, Wahner HW, et al. Stronger back muscles reduce the incidence of vertebral fractures: a prospective 10 year follow-up of postmenopausal women. Bone. 2002;30(6):836–841.
14. Wassertheil-Smoller S, Shumaker S, Ockene J, et al. Depression and cardiovascular sequelae in postmenopausal women: the Women’s Health Initiative (WHI). Arch Intern Med. 2004;164(3):289–298.
15. Beard JR, Heathcote K, Brooks R, Earnest A, Kelly B. Predictors of mental disorders and their outcome in a community based cohort. Soc Psychiatry Psychiatr Epidemiol. 2007;42(8):623–630.
16. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System. Atlanta, GA: National Center for Chronic Disease Prevention and Health Promotion; 2008.
17. Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance-United States, 2009. MMWR Surveill Summ. 2010;59(SS-5):1–148.
18. Lee SM. Physical activity among minority populations: what health promotion practitioners should know—a commentary. Health Promot Pract. 2005;6(4):447–452.
19. Robert Wood Johnson Foundation. Persistent gaps in health behaviors: physical inactivity. Available at: http://www.commissiononhealth.org/PDF/ed_inactiv.pdf. Accessed May 23, 2012.
20. Centers for Disease Control and Prevention. Physical activity and health: persons with disabilities. Available at: http://www.cdc.gov/nccdphp/sgr/disab.htm. Accessed May 24, 2012.
21. US National Physical Activity Plan Coordinating Committee. National Physical Activity Plan. Available at: http://www.physicalactivityplan.org/NationalPhysicalActivityPlan.pdf. Accessed September 1, 2011.
22. Pate R. A national physical activity plan for the United States. J Physical Activity Health. 2009;6(suppl 2):s157–s158.
23. National Prevention Strategy. Washington, DC: National Prevention Council; 2011.
24. United States Department of Health and Human Services. Action plan to reduce racial and ethnic health disparities. Available at: http://minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=285. Accessed May 12, 2012.
25. Chenowith D, Leutzinger J. The economic cost of physical inactivity and excess weight in American adults. J Physical Activity Health. 2006;3(2):148–163.