From Exercise to Physical Activity to Active Living: Expanding Possibilities for Research
and Intervention
James F. Sallis, PhD. Department of Family and Preventive Medicine
University of California, San Diego, USA
Abstract
Three phases in the evolution of the exercise science field can be identified. The initial phase
was the "exercise science" phase, with the research goals of understanding basic physiology
and improving sports performance. This phase generated vigorous physical activity goals for
enhancing physiological fitness. Main interventions were related to cardiac and
musculoskeletal rehabilitation. The second phase was the "physical activity" phase that began
in the 1980s and reflected the growing epidemiologic evidence linking physical activity with
health outcomes. This phase was marked by the moderate physical activity recommendations
in the 1990s, the US Surgeon General's Report in 1996, and multiple scientific reports.
Interventions were based in behavioral science and targeted both prevention in the general
population and rehabilitation for patients. The third and current phase is the "active living"
phase which expands the concept beyond leisure and recreation to transportation, occupation,
and household domains of physical activity. Active living is becoming a core part of public
health, and many disciplines outside of the health field are now collaborating on research and
interventions. There is a new emphasis on environmental and policy changes to complement
individually-oriented motivational and behavioral approaches. Exercise science has evolved
rapidly in concepts, methods, interventions, and disciplines involved. As the global health
burden of physical inactivity becomes increasingly clear, the need grows for interventions
that can have widespread and long-term influence on physical activity. Current approaches to
intervention that hold the most potential for meeting United Nation goals for reducing non
communicable diseases will be discussed.
Summary of Keynote Presentation
Although the health and moral benefits of physical activity have been recognized in early
writings from numerous cultures, exercise has never been a major focus of medicine or public
health. Now, there are major efforts to bring physical activity into the mainstream of both
medicine and public health. The field of exercise science has evolved rapidly in recent
decades, in part to meet societal needs. The goal of this talk is to summarize the evolution of
exercise science in three phases and describe current approaches to research and intervention
to counter the pandemic of physical inactivity that is responsible for more than 5.3 million
deaths worldwide each year.
The roots of exercise science are in physiology and sports, with some connection to physical
education. In the first phase, exercise was seen as a useful stimulus for examining
physiological processes, and exercise physiology developed as a basic science. There was
more interest in applications to sports performance than health. Physical education was an
applied discipline that goes back about 100 years in the United States, but it was not a
research-oriented field. Studies of the relation of exercise to multiple components of fitness
led to recommendations in the 1970s, such as those from the American College of Sports
Medicine, focusing on vigorous physical activity, Interventions were developed for cardiac
and musculoskeletal rehabilitation. This work was the basis for the "exercise revolution" in
the 1980s that was stimulated by new evidence on the effects of exercise on health, especially
cardiovascular diseases and longevity.
The epidemiologic studies signaled the second phase with a dominant emphasis on "physical
activity." Epidemiologic studies showed both physical activity and fitness were strongly
related to many health outcomes and served both preventive and therapeutic roles. Physical
activity and fitness studies were re-examined, and they revealed substantial fitness and health
gains with moderate-intensity physical activity. In the mid-1990's there were several
recommendations emphasizing moderate physical activity as a more accessible goal from
authoritative groups such as American College of Sports Medicine, US Surgeon General, and
American Heart Association, plus groups from many other countries. During this phase
interest in physical activity grew in the field of public health, and routine monitoring of
population physical activity began in many countries. Behavioral scientists developed and
evaluated many theory-based interventions targeting prevention, treatment, and rehabilitation
in a variety of population groups.
The third phase of "active living" began in the early 2000s, driven by three concepts. First,
the limitations of intervening to motivate and educate individuals were becoming apparent,
because changes were modest and short-lived. Multi-level ecological models were adopted
that guided interventions targeting a combination of individual factors, social factors,
environments, and policies. Second, investigators rediscovered that physical activity can be
done for transportation, occupation, and household purposes, not just recreation, leisure, and
sports. This opened new targets for intervention. Third, collaborations were developed with
disciplines that had expertise in this wider range of physical activity domains practiced in
diverse settings. Thus, city planners, transportation engineers, parks and recreation
professionals, physical educators, landscape architects, and architects, among others became
engaged in active living research and intervention.
Milestones in the active living phase included new interdisciplinary research programs, such
as Active Living Research and recommendations from the US Centers for Disease Control
and Prevention, US Institute of Medicine, and World Health Organization recommending
environment and policy change as essential for increasing physical activity and preventing
obesity. Walkability as a concept became known, and studies showing less physical activity
and more obesity in low-walkable suburbs received substantial media coverage in the US.
Cities throughout the world began implementing findings from the research by requiring
sidewalks, changing zoning codes, building bicycle facilities, renovating parks, and even
removing highways to re-establish pedestrian-friendly areas. Exercise Is Medicine is an
international movement to make exercise a "vital sign" and encourage health care providers
to counsel patients to be active.
Integration of active living into public health research and practice was accelerated by the
United Nations action plan to combat Non-Communicable Diseases (NCDs). In 2011, the UN
recognized that NCDs, such as heart disease, cancer; and diabetes are not just threats to
health, but they also can undermine economic development. Increasing physical-activity was
adopted as one of four strategic targets to 'combat NCDs, along with healthy diet, nonsmoking, and avoidance of excessive alcohol intake. A widely publicized series of papers in
The Lancet in 2012 showed that physical inactivity kills as many people as tobacco, at least
30% of adults and 70% of adolescents worldwide do not meet physical activity guidelines, a
variety of effective interventions are available that can be implemented, and physical
inactivity should be considered a global pandemic requiring urgent action. **
The new global efforts to promote physical activity come at a time when our storehouse of
evidence-based interventions is greatly expanding. The use of technologies to educate large
numbers of individuals through the internet and mobile telephones is exploding. Physical
activity experts realize they do not have all the skills needed, so multi-sector coalitions are
bringing together disciplines who have never worked with each other to devise new and long
lasting solutions to inactivity. Cities are adopting active living strategies in many agencies,
and they see such actions as improving both public health and economic development.
Though possibilities for interventions with broader reach and more permanent effects are a
positive development, implementing such strategies is more challenging than delivering
exercise classes, so all stakeholders involved in physical activity research and promotion
must develop new skills.
References
1. Beaglehole, R., Bonita, R., Horton, R., Adams, C., Alleyne, G., Asaria, P., et al. (2011).
Priority actions for the non-communicable disease crisis. The Lancet, 377, 1438-1447.
2. Hallal, P.C., Andersen, L.B., Bull, F.C., Guthold, R., Haskell, W.L., & Ekelund, U.
(2012). Global physical activity levels: Surveillance progress, pitfalls, and prospects.
The Lancet, 380, 247-257.
3. Heath, G.W., Brownson, R.C., Kruger, J.,. Miles, R., Powell, K., & Ramsey, L.T.
(2006). The effectiveness of urban design and land use and transport policies and practices to
increase physical activity: A systematic review. Journal of Physical Activity & Health, 3
(S1), S55-$76.
4. Kohl, H.W., Craig, C.L., Lambert, E.V., Inoue, S., Alkandari, J.R., Leetongin, G., &
Kahlmeier, S. (2012). The pandemic of physical activity: Global action for public
health. The Lancet, 380, 294-305.
5. Lee, I. M., Shiroma, E. J., Lobelo, F., Puska, P., Blair, S. N., & Katzmarzyk, P.T.
(2012). Effect of physical inactivity on major non-communicable diseases worldwide:
An analysis of burden of disease and life expectancy. The Lancet, 380, 219-229.
6. Sallis, J.F. (2011). Environmental and policy research on physical activity is going
global. Research on Exercise Epidemiology, 13(2), 111-117.
7. WHO. (2011). Global recommendations on physical activity for health. Geneva: World
Health Organization,
8. WHO. (2011). Physical inactivity: a global public health problem. Geneva: World
Health Organization.
9. WHO. (2004). Global Strategy On Diet, Physical Activity And Health. Geneva: World
Health Organization.
10. US Department of Health and Human Services. (2008). Physical Activity Guidelines
Advisory Committee Report. http://www.health.gov/paguidelines/