The purpose of this paper is to discuss the shared interest of the public health and parks and recreation sectors in promoting active visits to parks. At the institutional level, both sectors have missions to promote physical activity and view parks as key components in attaining physical activity goals. While some balancing among park goals may be necessary to avoid overuse and resource degradation, active visits more often complement park sustainability goals by reducing automobile and other motorized use impacts. The public health and parks and recreation sectors have each developed ecologic models to understand the determinants and outcomes of park-related physical activity. Transdisciplinary integration of these modeling efforts can lead to a better understanding of how active visits fit within the context of the overall recreational experience and the full range of benefits that parks provide. We conclude by identifying strategies for improving collaboration between the public health and parks and recreation sectors.
David M. Buchner and Paul H. Gobster
Amy I. Zlot, John Librett, David Buchner and Tom Schmid
This study examines environmental, transportation, social, and time barriers to physical activity.
Survey questions from the nationally representative Greenstyles survey (N = 2181) were summed to create environmental, transportation, social, and time barrier variables. Logistic regression was used to determine if the barrier variables had a significant association with physical activity levels.
Those who have low barriers to physical activity are more likely to meet the recommended physical activity levels compared with those with medium and high barriers. In addition, transportation, social capital, and time barriers independently contributed to the low levels of physical activity.
Removal of multiple barriers to physical activity may have an additive effect of increasing physical activity levels in Americans. Promoting physical activity requires strategies and research across multiple sectors to mitigate these barriers.
Daniel B. Bornstein, Russell R. Pate and David M. Buchner
Efforts to increase population levels of physical activity are increasingly taking the form of strategic plans at national, state/regional, and local levels. The processes employed for developing such plans have not been described previously. The purpose of this article is to chronicle the processes employed in and lessons learned from developing the US National Physical Activity Plan (NPAP).
The Coordinating Committee oversaw development of the NPAP. Key steps in the process included creating a private–public coalition based in the private sector, organizing the NPAP around 8 societal sectors, reviewing the evidence base for promotion of physical activity in each sector, conducting a national conference to initiate development of the NPAP’s core content, ensuring broad participation in developing and refining the NPAP, and launching the NPAP through a press event that attracted national attention.
Results and Conclusion:
The 3-year effort to develop the NPAP was guided by a private–public collaborative partnership involving private sector organizations and government agencies. Launched in May 2010, the NPAP included more than 250 evidence-based recommendations for changes to policy and practice at the national, state, and local levels across 8 societal sectors.
Susan A. Carlson, Judy Kruger, Harold W. Kohl III and David M. Buchner
Falls are a major health problem for older adults. The purpose of this study is to examine the cross-sectional association between non-occupational physical activity and falls and fall-related injuries in US adults age 65 y or older.
Respondents age 65 y or older were selected from the 2003 Behavioral Risk Factor Surveillance System (n = 47,619).
The age-adjusted incidence of falls was significantly higher among inactive respondents (16.3%, 95% CI: 15.2–17.6) than insufficiently active (12.3%, 95% CI: 11.4–13.2) or active (12.6%, 95% CI: 11.6–13.7) respondents. After controlling for sex, age, education, and body-mass index, active and insufficiently active respondents were significantly less likely to have fallen and were significantly less likely to have had a fall-related injury than their inactive peers.
These results show that active and insufficiently active older adults experience a lower incidence of falls than their inactive peers.
Larissa Roux, Mike Pratt, I-Min Lee, Terry Bazzarre and David Buchner
Community-based efforts to promote physical activity (PA) in adults have been found to be cost-effective in general, but it is unknown if this is true in middle-age specifically. Age group-specific economic evaluations could help inform the design and delivery of better and more tailored PA promotion.
A Markov model was developed to estimate the cost-effectiveness (CE) of 7 exemplar community-level interventions to promote PA recommended by the Guide to Community Preventive Services, over a 20-year horizon. The CE of these interventions in 25- to 64-year-old adults was compared with their CE in middle-aged adults, aged 50 to 64 years. The robustness of the results was examined through sensitivity analyses.
Cost/QALY (quality-adjusted life year) of the evaluated interventions in 25- to 64-year-olds ranged from $42,456/QALY to $145,868/QALY. Interventions were more cost-effective in middle-aged adults, with CE ratios 38% to 47% lower than in 25- to 64-year-old adults. Sensitivity analyses showed greater than a 90% probability that the true CE of 4 of the 7 interventions was below $125,000/QALY in adults aged 50 to 64 years.
The exemplar PA promotion interventions evaluated appeared to be especially cost-effective for middle-aged adults. Prioritizing such efforts to this age group is a good use of societal resources.
Patty Freedson, David M. Buchner, Russ Pate, Brad Hatfield, Loretta DiPietro, David A. Dzewaltowski, Tim Gavin and Jeff Nessler
This paper provides an overview of several university programs that have integrated various aspects of public health into their kinesiology instruction, research, and outreach efforts. The summaries of these programs provide the historical context that shows the various stages of transformation of their kinesiology and exercise science programs over the last century. Examples of specific academic structural designs and curricula are described, as well as the rationale the faculty used to justify these programs. In addition, advantages, opportunities, and challenges of this integration are highlighted.
M. Elaine Cress, David M. Buchner, Thomas Prohaska, James Rimmer, Marybeth Brown, Carol Macera, Loretta DiPietro and Wojtek Chodzko-Zajko
Physical activity offers one of the greatest opportunities for people to extend years of active independent life and reduce functional limitations. The article identifies key practices for promoting physical activity in older adults, with a focus on those with chronic disease or low fitness and those with low levels of physical activity. Key practices identified: (a) A multidimensional activity program that includes endurance, strength, balance, and flexibility training is optimal for health and functional benefits; (b) principles of behavior change including social support, self-efficacy, active choices, health contracts, assurances of safety, and positive reinforcement enhance adherence; (c) manage risk by beginning at low intensity but gradually increasing to moderate physical activity, which has a better risk:benefit ratio and should be the goal for older adults; (d) an emergency procedure plan is prudent for community-based programs; and (e) monitoring aerobic intensity is important for progression and motivation. Selected content review of physical activity programming from major organizations and institutions is provided.
Janet E. Fulton, David M. Buchner, Susan A. Carlson, Deborah Borbely, Kenneth M. Rose, Ann E. O’Connor, Janelle P. Gunn and Ruth Petersen
Physical activity can reduce the risk of at least 20 chronic diseases and conditions and provide effective treatment for many of these conditions. Yet, physical activity levels of Americans remain low, with only small improvements over 20 years. The Centers for Disease Control and Prevention (CDC) considered what would accelerate progress and, as a result, developed Active People, Healthy NationSM, an aspirational initiative to improve physical activity in 2.5 million high school youth and 25 million adults, doubling the 10-year improvement targets of Healthy People 2020. Active People, Healthy NationSM will implement evidence-based guidance to improve physical activity through 5 action steps centered on core public health functions: (1) program delivery, (2) partnership mobilization, (3) effective communication, (4) cross-sectoral training, and (5) continuous monitoring and evaluation. To achieve wide-scale impact, Active People, Healthy NationSM will need broad engagement from a variety of sectors working together to coordinate activities and initiatives.
Michael J. LaMonte, I-Min Lee, Eileen Rillamas-Sun, John Bellettiere, Kelly R. Evenson, David M. Buchner, Chongzhi Di, Cora E. Lewis, Dori E. Rosenberg, Marcia L. Stefanick and Andrea Z. LaCroix
Background: Limited data are available regarding the correlation between questionnaire and device-measured physical activity (PA) and sedentary behavior (SB) in older women. Methods: We evaluated these correlations in 5,992 women, aged 63 and older, who completed the Women’s Health Initiative (WHI) and Community Healthy Activities Model Program for Seniors (CHAMPS) PA questionnaires and the CARDIA SB questionnaire prior to wearing a hip-worn accelerometer for 7 consecutive days. Accelerometer-measured total, light, and moderate-to-vigorous PA (MVPA), and total SB time were defined according to cutpoints established in a calibration study. Spearman coefficients were used to evaluate correlations between questionnaire and device measures. Results: Mean time spent in PA and SB was lower for questionnaire than accelerometer measures, with variation in means according to age, race/ethnicity, body mass index, and functional status. Overall, correlations between questionnaires and accelerometer measures were moderate for total PA, MVPA, and SB (r ≈ 0.20–0.40). Light intensity PA correlated weakly for WHI (r ≈ 0.01–0.06) and was variable for CHAMPS (r ≈ 0.07–0.22). Conclusion: Questionnaire and accelerometer estimates of total PA, MVPA, and SB have at best moderate correlations in older women and should not be assumed to be measuring the same behaviors or quantity of behavior. Light intensity PA is poorly measured by questionnaire. Because light intensity activities account for the largest proportion of daily activity time in older adults, and likely contribute to its health benefits, further research should investigate how to improve measurement of light intensity PA by questionnaires.
Kenneth E. Powell, Abby C. King, David M. Buchner, Wayne W. Campbell, Loretta DiPietro, Kirk I. Erickson, Charles H. Hillman, John M. Jakicic, Kathleen F. Janz, Peter T. Katzmarzyk, William E. Kraus, Richard F. Macko, David X. Marquez, Anne McTiernan, Russell R. Pate, Linda S. Pescatello and Melicia C. Whitt-Glover
Background: The 2018 Physical Activity Guidelines Advisory Committee Scientific Report provides the evidence base for the Physical Activity Guidelines for Americans, 2nd Edition. Methods: The 2018 Physical Activity Guidelines Advisory Committee addressed 38 questions and 104 subquestions selected for their public health relevance, potential to inform public policies and programs, maturity of the relevant science, and applicability to the general US population. Rigorous systematic literature searches and literature reviews were performed using standardized methods. Results: Newly described benefits of physical activity include reduced risk of excessive weight gain in children and adults, incidence of 6 types of cancer, and fall-related injuries in older people. Physical activity is associated with enhanced cognitive function and mental health across the life span, plus improved mental health and physical function. There is no threshold that must be exceeded before benefits begin to accrue; the accrual is most rapid for the least active individuals. Sedentary time is directly associated with elevated risk of all-cause and cardiovascular mortality, incident cardiovascular disease and type 2 diabetes, and selected cancer sites. A wide range of intervention strategies have demonstrated success in increasing physical activity. Conclusion: The 2018 Physical Activity Guidelines Advisory Committee Scientific Report provides compelling new evidence to inform physical activity recommendations, practice, and policy.