Promoting Physical Activity to REAL People:
Practical Considerations and Concerns
T.K. Behrens Ph.D., CHES, FACSM
Health Promotion Laboratory, University of Colorado at Colorado Springs
Good Morning!
What is Physical Activity?
• Physical Activity
– “…any bodily movement that results in energy
expenditure”
•
•
•
•
Occupation
Transportation
Leisure-time
Activities of daily living (i.e., housework, etc.)
• Exercise
– Physical activity using large muscle groups that is
planned, structured, repetitive, and purposive
Casperson, 1985
Current PA Recommendation
• “Adults should do at least 150 minutes (2 hours and 30
minutes) a week of moderate-intensity, or 75 minutes
(1 hour and 15 minutes) a week of vigorous-intensity
aerobic physical activity, or an equivalent combination
of moderate- and vigorous-intensity aerobic activity.”
• “For additional and more extensive health benefits…
increase aerobic physical activity to 300 minutes (5
hours) a week of moderate-intensity, or 150 minutes a
week of vigorous-intensity aerobic physical activity…
Additional health benefits are gained by engaging in
physical activity beyond this amount. “
http://www.health.gov/paguidelines/guidelines/chapter4.aspx
Are we Doing it?
Physical Activity in U.S. Adults
50
45
40
35
30
25
20
15
10
5
0
Prevalence (%)
Active
Insufficient
Inactive
CDC, 2007
County-level Estimates of Leisure-time Physical Inactivity among Adults aged ≥ 20 years:
United States 2006
Age-adjusted percent
0 - 19.9
20.0 - 24.1
24.2 - 27.9
28.0 - 32.5
> 32.6
www.cdc.gov/diabetes
County-level Estimates of Leisure-time Physical Inactivity among Adults aged ≥ 20 years:
United States 2007
Age-adjusted percent
0 - 19.9
20.0 - 24.1
24.2 - 27.9
28.0 - 32.5
> 32.6
www.cdc.gov/diabetes
County-level Estimates of Leisure-time Physical Inactivity among Adults aged ≥ 20 years:
County-level Estimates of Leisure-time Physical Inactivity among Adults aged ≥ 20 years:
United States 2008
United States 2008
Age-adjusted percent
0 - 19.9
20.0 - 24.1
24.2 - 27.9
28.0 - 32.5
> 32.6
www.cdc.gov/diabetes
2006 Age-Adjusted Estimates of the Percentage
of Adults† Who Are Physically Inactive in
New Hampshire
2007 Age-Adjusted Estimates of the Percentage
of Adults† Who Are Physically Inactive in
New Hampshire
2008 Age-Adjusted Estimates of the Percentage
of Adults† Who Are Physically Inactive in
New Hampshire
The Burden of Physical Inactivity
• The Outcome
– Obesity, CVD, cancer, diabetes
– Physical inactivity is a primary
factor in over 200,000 deaths
annually
– 2 million deaths worldwide
• Small increases could affect 30K
to 35K deaths/yr
• Medical costs exceed $76
billion annually
– Comparable to tobacco costs
Why Aren’t We Doing It?
Which one is better for my unborn child?
Cultural Values?
Technology?
NY Times, 2008
Environmental Design?
No Time?
Current Time Trends
What Can WE Do to
Encourage Physical
Activity?
Be Grounded in Behavior Change Theory !
Transtheoretical Model
Social Ecological Model
Be Knowledgeable of Best Practices!
• The Guide to Community
Preventive Services
(the Community Guide)
www.thecommunityguide.org
• Recommended:
– Individually-adapted health
behavior change programs
– Social support interventions in
community settings
– Enhanced school-based physical
education
– Community-wide campaigns
– Community-scale urban design and
land use policies
– Creation of or enhanced access to
places for physical activity
combined with informational
outreach activities
– Street-scale urban design and land
use policies
– Point-of-decision prompts to
encourage use of stairs
Translation…
Incentives
• Behavioral economics?
• Typically results in higher HRA participation
rates for worksites if ~$100 is offered
• Careful of behavior tied to incentive
• May not translate to long-term behavior
change
Goetzel & Ozminkowski, 2008
Technology
Technology
• Has been demonstrated to increase EE over
sedentary activities in children
• Insufficient evidence otherwise
• Promising avenue?
Lanningham-Foster, 2009
Transportation
Transit Ridership and
Percent ‘Active Walkers’
Percent Active Walkers
30
25
20
15
10
5
0
Twice/week
Once/week
Some
Once
Frequency of Transit Use
Never
Active Transportation and Obesity Rates
30
70
40
15
30
10
20
5
10
Obesity Prevalence Based on Self-Report (%)
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Obesity Prevalence (%)
50
20
Walk + Bike + Transit Trips (%)
60
25
Walk + Bike + Transit Trips (% of Total)
Bassett et al., 2010
Negative Impacts of Suburbia
Less
Walking
More
driving
Suburbs
More energy
consumption
Less
exercise
More
pollution
More
pavement
More built
space
Less green
space
Worse
health
Poorly Designed Street Networks
Most transportation experts agree this road is
poorly designed
Completestreets.org
Designed for Multiple Uses
Most transportation experts agree this road is
better designed
Completestreets.org
Sport
Americans’ Use of Time Project
5
Hours Per Week
4
3
2
Communication
Sports/Exercise
Hobbies
Adult Education
1
0
1960
1970
1980
1990
2000
Godbey & Robinson, 1999
Guerilla Marketing
“Corn Maze”
Fitness First Bus Scale
Take a Walk in Zion: Preliminary Results
Media message
content
Environmental/
climate factors
Resistance to
protocol
Target
audience
Bus specific
differences
Trail
access
Community
involvement
Suggestions for
improvement
Trail specific
features
Non-pedestrian
factors
Behrens et al., APHA 2008
Sedentary to Active Time
•
•
•
•
•
•
Park far away
Take stair instead of elevators
Skip the stop
Stepping commercials
Play with children
More?
A N.E.A.T. Idea
Dr. James Levine
Mayo Clinic
Rochester, MN
Speed = 0. 7 mph
Your Ideas?
• Does it address multiple levels of influence?
• Does it address readiness to
change?
• Does it hold a relative advantage
over its predecessors?
• What is the complexity level?
• Is the program trialable?
• Is it convenient?
• Are the results observable?
• What is the time investment?
There’s nothing new under the …
Physical Activity Recommendation, 1786
• A horse gives but a kind
of half exercise, and a
carriage is no better than
a cradle. I sometimes
wonder whether we have
not lost more than we
gained by the use of this
animal. No one has
occasioned so much the
degeneracy of the human
body.
• Not less than two hours a
day should be devoted to
exercise, and the weather
should be little regarded.
-Thomas Jefferson
Henry David Thoreau, 1862
•
“I think that I cannot preserve
my health and spirits unless I
spend 4 hours a day…
sauntering through the woods
and over the hills and fields,
absolutely free from all
worldly engagements….”
•
“ I confess that I am
astonished at the endurance,
to say nothing of the moral
sensibility of my neighbors
who confine themselves to
offices the whole day for
weeks and months, aye, and
years almost together. I know
not what stuff they are [made]
of.”
Take Home Message
(What to tell your family and friends)
• Some Physical Activity Is Better Than None
• Additional Health Benefits With More Physical
Activity
• Additional Benefits With Vigorous Physical
Activity
• Accumulation of Physical Activity
Tips for Being More Active
There are 1440 minutes in every day... Schedule 30 of them for PA
• Walk, cycle, jog, skate, etc., to work, school, the store, or place of worship.
• Park the car farther away from your destination, or get on or off the bus
several blocks away.
• Take the stairs instead of the elevator or escalator.
• Play with children or pets.
• Perform gardening or home repair activities.
• Avoid labor-saving devices-turn off the self-propel option on your lawn
mower or vacuum cleaner.
• Use leg power-take small trips on foot to get your body moving.
• Exercise while watching TV (for example, use hand weights, stationary
bicycle/treadmill/stairclimber, or stretch).
• Dance to music.
• Keep a pair of comfortable walking or running shoes in your car and office.
You'll be ready for activity wherever you go!
www.cdc.gov
Tips for People Who Have Been Inactive
for a While
• Use a sensible approach by starting out slowly.
• Begin by choosing moderate-intensity activities you enjoy the most. By
choosing activities you enjoy, you'll be more likely to stick with them.
• Gradually build up the time spent doing the activity by adding a few
minutes every few days or so until you can comfortably perform a
minimum recommended amount of activity (30 minutes per day).
• As the minimum amount becomes easier, gradually increase either the
length of time performing an activity or increase the intensity of the
activity, or both.
• Vary your activities, both for interest and to broaden the range of benefits.
• Explore new physical activities.
• Reward and acknowledge your efforts.
www.cdc.gov
Questions?
For more information please contact
Tim Behrens
tbehrens@uccs.edu